Jacobson & Company Site Safety Audit

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

1. Working at Heights

• 1.1. Fall risks of 6' or more? (including voids, pits, and trenches)

  Safe

  At Risk

  N/A

• 1.2. Lack of edge protection?

  Safe

  At Risk

  N/A

• 1.3. Unsafe or incomplete edge protection?

  Safe

  At Risk

  N/A

• Add media

  Media

2. Scaffolds/Lifts

• 2.1. Unsafe or incomplete scaffold/lift?

  Safe

  At Risk

  N/A

• 2.2. Incompatible scaffold components? Unlabelled or do not meet AS?

  Safe

  At Risk

  N/A

• 2.3. Safe Work Load (SWL) exceeded? (tools, stored materials, number of persons)

  Safe

  At Risk

  N/A

• 2.4. Proper access to platform

  Yes

  No

  N/A

• 2.5. Properly secured & planked

  Yes

  No

  N/A

• 2.6. Proper guardrails

  Yes

  No

  N/A

• Add media

  Media

3. Harness and Equipment

• 3.1. Unsafe or damaged harness or equipment?

  Safe

  At Risk

  N/A

• 3.2. Incompatible hooks/equipment?

  Safe

  At Risk

  N/A

• 3.4. Unsafe or uncertified anchor points?

  Safe

  At Risk

  N/A

• 3.5. General condition of tools

  Safe

  At Risk

  N/A

• 1. Proper guards & cords

  Yes

  No

  N/A

• 2. Working GFCI

  Yes

  No

  N/A

• 3. Saw guards working/in use

  Yes

  No

  N/A

• 4. Extension cords

  Yes

  No

  N/A

• Add media

  Media

4. Ladders

• 4.1. Unsafe or damaged ladders?

  Safe

  At Risk

  N/A

• 4.2. Unsafe positioning of ladders?

  Safe

  At Risk

  N/A

• 4.3. Ladder not properly secured?

  Safe

  At Risk

  N/A

• 4.4. Ladder suitable for job? (e.g. metal ladder used for electrical work)

  Yes

  No

  N/A

• Add media

  Media

5. Personal Protective Equipment (PPE)

• 5.1. Head protection

  Yes

  No

  N/A

• 5.2. Proper foot protection

  Yes

  No

  N/A

• 5.3. Eye protection

  Yes

  No

  N/A

• 5.4. Gloves <br>

  Yes

  No

  N/A

• 5.5. Hearing protection

  Yes

  No

  N/A

• 5.6. Hi-Visibility vest

  Yes

  No

  N/A

• 5.7. Respirators for Tapers

  Yes

  No

  N/A

6. Administrative Procedures

• 6.1. Jacobson & Company "PIECE" poster on site and displayed

  Yes

  No

  N/A

• 6.2. Jacobson Worker Orientation forms completed

  Yes

  No

  N/A

• 6.3. "PIECE" stickers on hardhats

  Yes

  No

  N/A

• 6.4. MSDS, HASP, & Blue Book on site

  Yes

  No

  N/A

• 6.5. "Laser in Use" signs visible

  Yes

  No

  N/A

7. Site conditions

• 7.1 Is the job site clear of debris and other hazards?

  Safe

  At Risk

  N/A

• 7.2 Is OSHA protection adequate?

  Safe

  At Risk

  N/A

• 7.3 Are there any air quality issues that need to be addressed, ex. fumes, excessive dust, irritants?

  No

  Yes

• 7.4 Adequate lighting

  Yes

  No

  N/A

• 7.5 Excessive heat

  No

  Yes

Corrective Actions

• Enter any corrective actions that will be undertaken

Sign Off

• On site representative

  Sign

• Auditor's signature

  Sign