Information

  • Date - Initials - Job Number(s)

  • Job Name

General Project Information

  • Safety Manager Assigned to this project:

  • Site hours of operation:

  • List Sub-Contractors and Competent Persons per sub:

  • Prepared by

  • Weather Conditions

  • Conducted on

  • Location

1. Planned / Scheduled work for the day.

  • 1a. Pre-Task / Safety Briefing prior to start of work?

  • 1b. Work performed according to plan?

  • Brief description of work to be performed.

  • 1c. Adequate tools, materials and Safety controls to perform work?

2. Ladders / Scaffold

  • 2a. Unsafe or damaged ladders discarded, destroyed, and removed from site?

  • 2b. Ladders properly positioned?

  • 2c. Ladders properly secured?

  • 2d. Is scaffold present on site?

  • 2e. Was scaffolding erected according to plan, and by qualified person?

  • 2f. Is inspection tag present and completed by competent person?

  • List responsible party for scaffold, type of scaffold, inspection frequency and competent person:

3. Emergency Response

  • 3a. Adequate emergency plans for site?

  • 3b. Emergency procedures displayed at site?

  • 3c. Adequate first aid kits and equipment for site?

4. Personal Protective Equipment (PPE)

  • 4a. Adequate PPE supplied / utilized?<br>

  • 4b. Appropriate training in safe use, clean-up and inspection of PPE?

5. Fall / Perimeter Protection

  • 5a. Guard rails at required height?

  • 5b. Holes greater than 2" covered, secured, and clearly marked?

  • 5c. Fall arrest plan, equipment, & personnel properly trained?

  • 5d. Are all fall exposures from any height protected?

6. Lifting Equipment

  • 6a. Hoisting Equipment adequate for task at hand? (Right machine for the task?)

  • 6b. All workers, and operators aware of hoisting loads over head and near power lines, practices and procedures according to company policy and OSHA Standards?

  • 6c. Unsafe or damaged lifting equipment, including ropes, slings, chains, hooks removed from service?

7. Work Environment

  • 7a. Sufficient lighting?

  • 7b. Adequate housekeeping?

  • 7c. Adequate access/egress provided to the site and all work areas?

8. Flammable Liquids

  • 8a. Are flammable liquids being properly stored?

9. Incidents, Accident, Injury, Near Miss

  • 9a. Were there any incidents, injuries, accidents or near miss' to report today?

  • 9b. Detailed information narrative?

  • 9c. Detailed Information Photo's

10. Electrical Hazards

  • 10a. GFCI outlets inspected regularly?

  • 10b. Electrical equipment placed away from water?

  • 10c. Extension cords inspected prior to use?

  • 10d. Electrical equipment at safe distance from flammables?

  • 10e. Are all power tools inspected prior to use?

11. Lock Out/Tag Out: Hazardous Energy, Equipment or Other.

  • 11a. Lock-out/tag-out (LOTO) procedures for electrical or other hazardous equipment?

12. Excavations

  • 12a. Will excavation work be performed today?

  • 12b. Has an excavator Corporate Safety Program been submitted to Superintendent?

  • 12c. Is there a competent person for excavating on site?

  • 12d. Is there an excavation plan, with associated "DIG" numbers reviewed and approved?

  • 12e. Are Safety restraint belts in place and being used?

  • 12f. Are 'BACK-UP'or other movement alarms in place and functioning properly?

  • 12g. Is traffic control required, and in place according to 'traffic control plan'?

  • 12h. Are Flaggers required?

  • Are the Flaggers certified according to City, State, & OSHA standards?

  • Are the Flaggers trained for the task at hand, and familiar with surrounding activities?

  • 12i. Have open excavations been protected?

  • 12j. Is shoring designed by a Structural Engineer?

  • 12k. Is contaminated material being handled according to plan and disposed of properly in accordance to EPA expectations?

  • 12L. Is erosion control in place? I.e: silt fence, drain screens, pump sock - filter bag, etc...

  • 12m. Has all earth work been inspected by the competent person prior to entering?

  • 12n. Are precautionary measures in place for dewatering trenches / excavations?

  • 12o. Have proper permits been acquired prior to digging?

  • 12p. Has the soil been tested to determine classification by the competent person?

  • 12q. Is benching, sloping, shoring, or shielding required?

  • 12r. Is any special insurance required, if so, has it been obtained? (RR Prospective, etc..)

  • 12s. Are dust control and street sweeping equipment being used? ie... Water truck - Street sweeper

  • 12t. Are there any atmospheric hazards?

  • 12u. Are access & egress points in place according to standards?

13. Administrative Procedures

  • 13a. Procedure for incident reporting followed? (Incident, witness, injury, etc.)

  • 13b. Has proper orientation been provided to workers, contractors, visitors?

  • 13c. Proper permits acquired prior to task? (Hot Works, Confined Space etc)

  • 13d. Site Safety Plan readily available?

  • 13e. Supervision on site? (List Supt. & PM)

  • 13f. Appropriate consultative arrangements? (Ability to get resolution to concerns)

  • 13g. Routine inspections, monitoring, audits submitted regularly?

14. Tower & Mobile Cranes

  • 14a. Is there a crane on site today?

  • 14b. Are crane inspections current and copies available?

  • 14c. Is the load chart readily available, legible, and being followed?

  • 14d. Are signal persons and riggers qualified with proof readily available?

  • 14e. Are all hook 'Safety Locks' in working order?

  • 14f. Is crane positioned at the correct safe distance from over-head power lines?

  • 14g. Are outriggers properly padded?

  • 14h. Are access ladders and steps properly protected and in good condition?

  • 14i. Does the operator have appropriate licensing accord to Job, City, & State requirements?

  • 14j. Is all rigging properly tagged and regularly inspected?

15. Site exterior condition.

  • 15a. Are all perimeter side walks clean?

  • 15b. Is all public protection in place and in good visible / functional condition?

  • 15c. Are all pedestrian pathways clean, clear of debris and clearly marked or identified?

  • 15d. Is all signage for detoured walk ways in place? i.e. 'Sidewalk closed' 'use other side' 'over head work'

  • 15e. Are canopies being used, if YES, have all hazards been eliminated? i.e.(falling debris/material, sharp edges, trip hazards)

  • 15f. Are there any temporary walkways, if yes, are the ADA (American Disability Act) compliant?

16. Site Security

  • 16a. Is the site fenced to prevent un-authorized entrance?

  • 16b. Are equipment and job trucks locked at the end of shift to prevent un-authorized use?

  • 16c. Are materials and equipment stored in a secure area to prevent theft?

  • 16d. List any site security measures that are currently in place for the site, i.e. security cameras or night time security personnel.

17. Atmospheric: Lead, Asbestos, Silica

  • 17a. Have potential atmospheric hazards been Identified? (If yes, please describe)<br>

  • 17b.Has formal testing been performed prior to beginning of task to identify hazard and exposure levels?

  • 17c. Has the hazard been remediated / abated, if yes, by whom? (please provide copies of completion reports)

  • 17d. Are employee's provided with appropriate PPE to be protected from exposure to hazard?

18. General Duty Clause, Miscellaneous Findings & Other Safety Observations

  • 18a. Were observations or miscellaneous findings that pose a potential hazard discovered during audit process?

  • 18b. Were there deficiencies that aren't listed discovered during audit process?

  • Brief description & photo:

19. Corrective Actions

  • 19a. Enter any corrective actions that will be undertaken

  • Add media

Sign Off

  • Auditor's signature

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