IX Original Field Safety Audit

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Documentation

• General comments:

  Yes

  No

  N/A

• State and Federal Listing posted at the site<br>

  Yes

  No

  N/A

• Daily Job Safety Analysis reviewed, updated and signed

  Yes

  No

  N/A

• Emergency contact list posted

  Yes

  No

  N/A

• Documentation of corrective actions taken since last audit?

  Yes

  No

  N/A

• Weekly safety meetings being completed

  Yes

  No

  N/A

• Weekly equipment checklist completed

  Yes

  No

  N/A

• Copy of safety manual, MSDS, tabulated data

  Yes

  No

  N/A

Subcontractor Compliance

• General comments:

  Yes

  No

  N/A

• Subcontractor per-construction meeting completed and documented.

  Yes

  No

  N/A

• Drug testing information collected.

  Yes

  No

  N/A

• Subcontractors have submitted training documentation for he task that will perform.

  Yes

  No

  N/A

• Subcontractors have completed a JSA for the task that they will complete. <br><br><br><br>

  Yes

  No

  N/A

• Subcontractors have completed and submitted weekly safety meetings.

  Yes

  No

  N/A

• Subcontractors are complying with PPE requirements.

  Yes

  No

  N/A

Personal Protective Equipment (PPE)

• General comments:

  Yes

  No

  N/A

• Eye protection including side shields (100%)

  Yes

  No

  N/A

• Head protection (100%)<br>

  Yes

  No

  N/A

• Hearing protection required and worn

  Yes

  No

  N/A

• High visibility clothing / vests worn by none burning or climbing employees.(100%)

  Yes

  No

  N/A

• Respiratory protection equipment worn and stored properly where required.

  Yes

  No

  N/A

• Speciality PPE (face shields, FR clothing)

  Yes

  No

  N/A

Fall Protection

• General comments:

  Yes

  No

  N/A

• Fall protection required (All work over 6' requires fall protection)

  Yes

  No

  N/A

• Have all employees who are working at height (6' or greater) trained in fall protection.

  Yes

  No

  N/A

• Have the fall hazards been addressed in a JSA

  Yes

  No

  N/A

• Harnesses, SRL's, and fall protection equipment has been inspected before use and in good condition

  Yes

  No

  N/A

• What form of rescue will be used in the event a fall takes place.

  Yes

  No

  N/A

Holes

• General comments:<br>

  Yes

  No

  N/A

• Have all holes been properly protected. (2" or greater)

  Yes

  No

  N/A

• Have all hole covers been properly secured, and markerd with the words" HOLE".

  Yes

  No

  N/A

Guardrails

• General comments:

  Yes

  No

  N/A

• Toprail 42+/- 3", Midrail 21+/3", Toe board.

  Yes

  No

  N/A

• Cable Guardrail: Top rail 42" +/- 3", do not deflect below 39". <br>

  Yes

  No

  N/A

• Stanstions on 8' centers. <br>

  Yes

  No

  N/A

• Flagging placed every 6'.

  Yes

  No

  N/A

• Free from laceration hazards.

  Yes

  No

  N/A

• Completely protects against the hazard.

  Yes

  No

  N/A

Ladders & Barricades

• General comments.

  Yes

  No

  N/A

• Have all ladders been inspected before use.

  Yes

  No

  N/A

• Do ladders have proper footing.

  Yes

  No

  N/A

• Are ladders used in a dully opened position.

  Yes

  No

  N/A

• Is the ladder positioned so the base of the ladder is one foot away for every four feet of height. (4:1 ratio)

  Yes

  No

  N/A

• Do side rails extend 36" above the landing area.

  Yes

  No

  N/A

• Have ladders been properly secured.

  Yes

  No

  N/A

• Employees maintaining 3 points of contact when using the ladder.

  Yes

  No

  N/A

• Can work be performed within the confines of the side rails.

  Yes

  No

  N/A

Excavation Safety

• General comments:

  Yes

  No

  N/A

• Has a Competent person been assigned to the task

  Yes

  No

  N/A

• Has the Utility One Call been made. Are marking updates being made, and information being received.

  Yes

  No

  N/A

• Have underground utilities been identified / located and marked

  Yes

  No

  N/A

• Have adjacent structures / utilities been properly protected or supported. <br>

  Yes

  No

  N/A

• Has the trench / excavation been inspected before entry's

  Yes

  No

  N/A

• Is a ladder or acceptable means of egress provided in all trenches / excavations 4' or deeper

  Yes

  No

  N/A

• Are excavations 5' deep or deeper properly protected. (Sloped, bench, shielded, or shored)

  Yes

  No

  N/A

• Are trench boxes in good condition, spreaders properly installed, stacking pins in place. <br><br>List Box numbers:<br><br><br>

  Yes

  No

  N/A

Vehicles & Equipment

• General comments:

  Yes

  No

  N/A

• Is all equipment equipped with a fire extinguisher (Extinguishers inspected and up-dated)<br><br><br>

  Yes

  No

  N/A

• Are all safety devices in place and working (Back-up alarms, etc..)<br>

  Yes

  No

  N/A

• Power lines de-energized and/or safe distance from equipment (10 feet)

  Yes

  No

  N/A

• Is demolition equipment equipped with safety cages (Including hammering operation)

  Yes

  No

  N/A

• Aerial lifts inspected and used properly (Controls inspected and tested daily)

  Yes

  No

  N/A

• Crane operators NCCO License current and on file.

  Yes

  No

  N/A

• Daily crane inspection completed

  Yes

  No

  N/A

• Swing radius protected

  Yes

  No

  N/A

• Prelift form completed before all lifts.

  Yes

  No

  N/A

• Rigging inspected before all lifts.

  Yes

  No

  N/A

• All chains / nylon / wire rope slings labeled.

  Yes

  No

  N/A

• Shackles and hooks inspected for deformation, keepers present.

  Yes

  No

  N/A

• Loads rigged by a qualified rigger.

  Yes

  No

  N/A

• Crane maintaining 20' from overhead powerlines, or if voltage is known, following Table A.

  Yes

  No

  N/A

Material Handleing and Concrete Construction

• General comments:<br>

  Yes

  No

  N/A

• Men lifting correctly.

  Yes

  No

  N/A

• Are form brackets inspected.

  Yes

  No

  N/A

• Walkways over rebar mats.

  Yes

  No

  N/A

• Has all reinforcement bar that presents an impalment, or cut hazard been protected

  Yes

  No

  N/A

• Materials properly stored, labeled and stacked.

  Yes

  No

  N/A

Housekeeping and Sanitation

• General comments:<br>

  Yes

  No

  N/A

• General neatness of the working areas

  Yes

  No

  N/A

• Tool trailer & conex organized and clean.

  Yes

  No

  N/A

• Proper and safe access and egress to tool trailers and offices.

  Yes

  No

  N/A

• Waste containers provided and used.

  Yes

  No

  N/A

• Adequate supply of drinking water on-site.

  Yes

  No

  N/A

• First aid equipment on-site and accessible.

  Yes

  No

  N/A

• Sanitary facilities adequate and clean.

  Yes

  No

  N/A