Jacobson & Company Site Safety Audit

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Personal Protective Equipment (PPE)

• Head protection

  Yes

  No

  N/A

• Proper foot protection

  Yes

  No

  N/A

• Eye protection

  Yes

  No

  N/A

• Face protection if using saw?

  Yes

  No

  N/A

• Gloves <br>

  Yes

  No

  N/A

• Hearing protection

  Yes

  No

  N/A

• Hi-Visibility vest

  Yes

  No

  N/A

• Dust masks for Tapers

  Yes

  No

  N/A

Working at Heights (Open Air Project)

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

  Safe

  At Risk

  N/A

• Lack of edge protection?

  Safe

  At Risk

  N/A

• Unsafe or incomplete edge protection?

  Safe

  At Risk

  N/A

• Damaged edge protection?

  Yes

  No

  N/A

• Add media

  Media

Scaffolds/Lifts

• Unsafe or incomplete scaffold/lift?

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

• Proper access to platform

  Yes

  No

  N/A

• Properly secured & planked

  Yes

  No

  N/A

• Outriggers on securely and properly?

  Safe

  At Risk

  N/A

• Guardrails set at appropriate height (top rail: 39"-45")

  Yes

  No

  N/A

• Add media

  Media

Harness and Equipment

• Are the harnesses, if any, damaged/tarnished/illegible manufacturers label?

  Safe

  At Risk

  N/A

• Incompatible hooks/equipment?

  Safe

  At Risk

  N/A

• Unsafe or damaged equipment?

  Safe

  At Risk

  N/A

• Unsafe or uncertified anchor points?

  Safe

  At Risk

  N/A

• General condition of tools

  Safe

  At Risk

  N/A

• Proper guards & cords

  Yes

  No

  N/A

• Working GFCI

  Yes

  No

  N/A

• Extension cords

  Yes

  No

  N/A

• Saw guards working/in use

  Yes

  No

  N/A

• Is there a shroud to cover the area in which the saw is being used?

  Yes

  No

  N/A

• Is the saw on an elevated, level platform?

  Yes

  No

  N/A

• Add media

  Media

Ladders

• Unsafe or damaged ladders?

  Safe

  At Risk

  N/A

• Unsafe positioning of ladders?

  Safe

  At Risk

  N/A

• Ladder not properly secured?

  Safe

  At Risk

  N/A

• Ladder suitable for job?

  Yes

  No

  N/A

• Add media

  Media

Administrative Procedures

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

  Yes

  No

  N/A

• Jacobson Worker Orientation forms completed

  Yes

  No

  N/A

• "PIECE" stickers on hardhats

  Yes

  No

  N/A

• MSDS, HASP, & Blue Book on site

  Yes

  No

  N/A

• "Laser in Use" signs visible

  Yes

  No

  N/A

• Have signed Tool Box Talks on site?

  Yes

  No

  N/A

Site conditions

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

  Safe

  At Risk

  N/A

• Is OSHA protection adequate?

  Safe

  At Risk

  N/A

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

  No

  Yes

• Adequate lighting

  Yes

  No

  N/A

• Excessive heat

  No

  Yes

Miscellaneous Information

Corrective Actions - INCLUDE NAMES

• Enter any corrective actions that will be undertaken

Sign Off

• On site representative

  Sign

• Auditor's signature

  Sign