JOB SITE SAFETY INSPECTION

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Instructions: To be completed by supervisor prior to beginning of new job, when changes in work procedures occur, or when additional hazards are present. Reference related Job Hazard Analysis, Health and Safety Code Handbook direction and ensure this form is maintained for records.

PERSONAL PROTECTIVE EQUIPMENT

• Safety approved hard hat worn when falling object is present?

  Yes

  No

  N/A

• Safety approved footwear worn at all times?

  Yes

  No

  N/A

• Protective eyewear worn where required?

  Yes

  No

  N/A

• Hand protection used where required?

  Yes

  No

  N/A

• Are personal fall protection- full body harness and lanyard up to date in good working order and being used when necessary?

  Yes

  No

  N/A

• Hearing protection worn where required?

  Yes

  No

  N/A

MACHINERY

TOOLS AND EQUIPMENT

• Are electric hand tools in good working order- free from broken and/ or missing parts, including cord?

  Yes

  No

  N/A

• Are air tools in good working order- free from broken and/ or missing parts?

  Yes

  No

  N/A

• Are gas powered tools in good working order- free from broken and/ or missing parts?

  Yes

  No

  N/A

• Are non powered hand tools in good working order- free from broken and/ or missing parts?

  Yes

  No

  N/A

• If any heavy machine(s) are on site are they well maintained and/ or serviced regularly?

  Yes

  No

  N/A

• Are compressors and/ or generators in good working order- free from broken and/ or missing parts?

  Yes

  No

  N/A

• Are any work vehicles on site well maintained and/ or serviced regularly?

  Yes

  No

  N/A

FIRST AID AND SAFETY

• Are there appropriate first aid kit(s) on site and well maintained?

  Yes

  No

  N/A

• Is an emergency eyewash kit accessible?

  Yes

  No

  N/A

• Is an emergency evacuation plan in place and well known by all workers?

  Yes

  No

  N/A

• Are appropriate fire extinguisher(s) in place and up to date?

  Yes

  No

  N/A

• Is a certified first aid person available on site?

  Yes

  No

  N/A

• Are safety rails or guards in place- wall openings and floor holes covered or guarded?

  Yes

  No

  N/A

• Are extension and step ladders safe, inspected and used in an appropriate manner?

  Yes

  No

  N/A

• Are appropriate scaffolding being used and in good working order?

  Yes

  No

  N/A

• Is general house keeping appear neat and orderly?

  Yes

  No

  N/A

CORRECTIVE ACTION PLAN

• Action and Status Taken

SIGNATURE OF QUALIFIED SUPERVISOR

• Name:

  Sign