Title Page
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Date (yyyymmdd Format)
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Job Number:
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Job Name:
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Site Supervision:
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Site Safety Manager:
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Weather Conditions:
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Location
Site Administration
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Have all employees, subcontractor employees, and visitors completed the site orientation process and been issued a job sticker?
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Corrective Action Taken:
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Are all Contractors that are working onsite enrolled in CCIP?
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Corrective action
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Are all required Job Posters (OSHA, IDOT, DOL, etc), Ethics Notifications, and Emergency Numbers conspicuously posted?
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Corrective Action Taken:
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Are the Site Safety Manual and SDS/Hazcom Book current and readily available?
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Corrective Action Taken:
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Are First-Aid Kits readily available, stocked, and contents not expired?
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Corrective Action Taken:
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Are AED present on onsite and located in designated locations?
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Corrective Action
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Are Pre-Task Plans and/or Take-5 Books being completed on a daily and as necessary basis?
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Corrective Action Taken:
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Are weekly Toolbox Talks/Safety Trainings being held and documented?
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Corrective Action Taken:
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Are stretch and flex exercises being performed prior to the start of work and as necessary daily?
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Corrective Action Taken:
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Is the site entrance/exit clearly identified and all informational signage(i.e. No Trespassing, PPE requirements, Office Location, etc.) in place?
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Corrective Action Taken:
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Is required informational and warning signage in place throughout the project? (i.e. EXIT, NO EXIT, Fire Extinguisher, Floor Numbers, etc)
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Corrective Action Taken:
Personal Protective Equipment
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Is all required company supplied PPE stocked on-site and readily available?
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Corrective Action Taken:
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Were all observed personnel wearing the required PPE at time of audit? ( Hardhat, Safety Glasses, Class II vest, And Gloves)
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Corrective Action Taken:
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Are Face shields or full face respirators being worn for all cutting or grinding operations?
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Corrective Action
Fall Protection
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Have all identified fall from height hazards been controlled?
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Corrective Action Taken:
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Was all observed fall arrest equipment, such as, harnesses, SRLs, and anchorages free from obvious damage and appear to be in working order?
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Corrective Action Taken:
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Were all observed guard rails (wood) in place, built, and maintained according to standards? ( Top rail 42 "+/- 3" able to hold 200lb of downward and outward force, Midrail 21" +/- 3" able to hold 150lb of downward and outward force, toe board made with at least 1x4" lumber and able to hold 50lbs of force, Blue netting is also in place to keep debris from blowing off the building from top rail to toe board.)
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Corrective Action Taken:
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Were all observed guard rails (wire rope) in place, built, and maintained according to standards? (TurnBuckles should be in place in every run of guardrail, Top rail 42 "+/- 3" able to hold 200lb of downward and outward force and not deflect more then 3" in any direction, Midrail 21" +/- 3" able to hold 150lb of downward and outward force and not able to deflect more then 3" in any direction, toe board made with at least 1x4" lumber and able to hold 50lbs of force, Blue netting is also in place to keep debris from blowing off the building from top rail to toe board.)
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Corrective Action
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Were all observed holes 2" or greater in their smallest dimension securely covered and clearly marked "HOLE"?
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Corrective Action Taken:
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Are Look-out Platforms being utilized on this site?
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Have all structural installation plans been reviewed, approved, and followed for Look-out installation?
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Corrective Action Taken:
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Were all observed impalement hazards both vertical and horizontal protected?<br> (rebar, conduit, pipe, nails, etc)
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Corrective Action Taken:
Electrical
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Is Temporary or Permanent lighting in place and adequate amount for the area?
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Corrective Action
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Is Lighting (both Permanent and Temp) in proper condition? Free from broken Bulbs, Open recticales, Burnt out bulbs, Missing Cage etc)
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Corrective Action
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Have all known exposures to high voltage been controlled?
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Corrective Action Taken:
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Did all observed breaker boxes have secure doors and were clearly marked/labeled with Controlling Contractors name and Voltage?
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Corrective Action Taken:
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Were all observed extension cords and power tools free from physical damage such as faults in insulation, missing grounds, missing guards, faulty triggers, etc?
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Corrective Action Taken:
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Did all observed electrical boxes, switches, and receptacle have tight fitting cover or plates, have all "Knock Outs" or holes covered protected or sealed, and have weatherproofing where needed?
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Corrective Action Taken:
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Were all observed electrical receptacles protected by Working GFCI?
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Corrective Action Taken:
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Did all observed electrical rooms have doors, signage with Gurtz contact information, and were secured to prevent unauthorized access?
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Corrective Action Taken:
HOT Work (Welding, cutting, burning, torch)
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Was there any work requiring a "Hot Work Permit" being performed?
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Were proper permits obtained before starting the work?
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Corrective Action Taken:
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Was the observed hot work being performed being done in accordance with the terms of the permit? (Permit posted, fire extinguishing method present, fire watch utilized, area clean and flammables protected if present)
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Corrective Action Taken:
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Does Hot work permit board match the location of all hot work going on?
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Corrective Action
Fire Prevention
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Were fire extinguishers on site clearly visible and being maintained?
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Corrective Action Taken:
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Were all observed flammable liquids in approved containers such as gas cans with spring loaded closures and flame arresters, and stored in an acceptable manner when not in use?
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Corrective Action Taken:
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Were all observed compressed gas cylinder being stored, handled, used, and transported correctly?<br>
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Corrective Action Taken:
Ladders and Scaffold
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Were any ladders observed to be in use or available for use on site?
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Were ladders in use or available for use observed to be free of any obvious defects, damage, or excessive wear; have all warning, instruction and capacity labels visible and legible; and be positioned, used, secured, and stored correctly?
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Corrective Action Taken:
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Were any observed job built ladders built in accordance with ANSI standards?
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Corrective Action Taken:
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Are ladder access and landing areas free from debris and other hazards?
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Corrective Action Taken:
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Where stair towers in place and inspected?
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Corrective Action
Housekeeping
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8a. Were all walkways, stairways, ladder accesses, and work areas observed to be maintained in a clean and passable fashion?
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Corrective Action Taken:
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Were stored materials observed to be neat, orderly, not leaning up on walls or handrail and secured from falling over?
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Corrective Action Taken:
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Were there an adequate number of maintained Facilities/Porta-potties and personal hygiene/wash stations on site and accessible to meet requirements and standards?
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Corrective Action Taken:
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Have perimeter protection controls been put into place to prevent the dislodgment of materials, tools and debris?
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Corrective Action Taken:
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Are trash container readily available and maintained?
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Corrective Action Taken:
Cranes (Tower and Mobile)
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Were cranes observed to be in use on site?
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- Tower
- Mobile
Tower Crane
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Is the crane being inspected and maintenance being performed per manufacturers specification?(Daily, Periodic, Annual)
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Corrective Action Taken:
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Are crane communications systems in use and functioning for all foreseen tasks?
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Corrective Action Taken:
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Have security measure been taken to prevent unauthorized access and secure the crane when not in use?
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Corrective Action Taken:
Mobile Crane
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Have all crane planning and pre-assembly meetings taken place and been documented?
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Corrective Action Taken:
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Was the crane assembled and inspected by competent and qualified personnel per governing regulations and guidelines?
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Corrective Action Taken:
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Is the crane being inspected and maintenance being performed per manufacturers specification?(Daily, Periodic, Annual)
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Corrective Action Taken:
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Are crane communications systems in use and functioning for all foreseen tasks?
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Corrective Action Taken:
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Have security measure been taken to prevent unauthorized access and secure the crane when not in use?
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Corrective Action Taken:
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When observed did the crane appear to be in good operating condition and being operated in a safe manner with all safety devices in place and with due regard to personnel and surroundings?
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Corrective Action Taken:
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Are any critical lifts being performed?
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Have all critical lift plans been submitted to and reviewed by all appropriate parties?
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Corrective Action Taken:
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Is the lift being performed in accordance with the submitted and reviewed plan?
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Corrective Action Taken:
Scissor and Boom Lifts
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Where any Scissor or Boom Lifts observed in use on site today?
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Is the equipment being inspected daily by a trained user/competent person and records of those inspections available?
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Corrective Action Taken:
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When observed did the equipment appear to be free from any obvious damage or defects, appear to operating correctly, and appear to be being operated with due regard to personnel and surroundings?
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Corrective Action Taken:
Confined Space
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Have all confined spaces on site been identified and their locations made known to all on site personnel?
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Corrective Action Taken:
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Is any work requiring confined space entry being performed at this time?
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Have all entry and other required permits been acquired prior to entry?
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Corrective Action Taken:
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Is the entry being performed in accordance with the terms and requirements of the permit?
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Corrective Action Taken:
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Are outside working platforms of windscreens and SKE's clean and free from debris? Any material stored on platforms should be secured in place.
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Corrective Action
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Are the gaps between wind screens on the platforms covered by rubber overlay and are plywood cants in place at bottom level of windscreen in place?
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Corrective action
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If Wind screens or SKE's are being jump is there someone on ground watching the CAZ to make sure no one enters that area?
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Corrective Action
Silica
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Is there any work going on that causes an exposure to Silica?
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Are proper controls in place to eliminate exposure to Silica?
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What Controls are being used?
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Corrective Actions
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Is signage up warning people in the area that Silica work is being done?
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Was any grinding being done, If so was employee using Grinder with vacuum attachment and respirator?
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Corrective Action
General Duty Safety Observations
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Were other observations or miscellaneous findings that pose a potential hazard discovered during the audit process?
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Note Observed Condition or Action:
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Corrective Action Taken:
Incidents
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Were there any near miss, property damage or personal injury incidents to report today?
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Viewpoint Reference Number:
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Incident Description:
Preventative, Corrective, and Disciplinary Actions
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15a. Were there any preventative, corrective, or disciplinary actions not previously noted taken today?
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Description of Action Taken:
Audit Conducted By
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