Information
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
1. Working at Heights
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1.1. Fall risks of 6' or more? (including voids, pits, and trenches)
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1.2. Lack of edge protection?
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1.3. Unsafe or incomplete edge protection?
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2. Scaffolds/Lifts
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2.1. Unsafe or incomplete scaffold/lift?
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2.2. Incompatible scaffold components? Unlabelled or do not meet AS?
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2.3. Safe Work Load (SWL) exceeded? (tools, stored materials, number of persons)
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2.4. Proper access to platform
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2.5. Properly secured & planked
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2.6. Proper guardrails
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3. Harness and Equipment
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3.1. Unsafe or damaged harness or equipment?
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3.2. Incompatible hooks/equipment?
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3.4. Unsafe or uncertified anchor points?
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3.5. General condition of tools
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1. Proper guards & cords
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2. Working GFCI
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3. Saw guards working/in use
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4. Extension cords
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4. Ladders
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4.1. Unsafe or damaged ladders?
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4.2. Unsafe positioning of ladders?
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4.3. Ladder not properly secured?
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4.4. Ladder suitable for job? (e.g. metal ladder used for electrical work)
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5. Personal Protective Equipment (PPE)
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5.1. Head protection
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5.2. Proper foot protection
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5.3. Eye protection
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5.4. Gloves <br>
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5.5. Hearing protection
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5.6. Hi-Visibility vest
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5.7. Respirators for Tapers
6. Administrative Procedures
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6.1. Jacobson & Company "PIECE" poster on site and displayed
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6.2. Jacobson Worker Orientation forms completed
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6.3. "PIECE" stickers on hardhats
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6.4. MSDS, HASP, & Blue Book on site
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6.5. "Laser in Use" signs visible
7. Site conditions
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7.1 Is the job site clear of debris and other hazards?
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7.2 Is OSHA protection adequate?
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7.3 Are there any air quality issues that need to be addressed, ex. fumes, excessive dust, irritants?
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7.4 Adequate lighting
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7.5 Excessive heat
Corrective Actions
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Enter any corrective actions that will be undertaken
Sign Off
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On site representative
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Auditor's signature
