Job Site Safety Survey

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Traffic Control Devices

• Advance Warning Signs

  Yes

  No

  N/A

• Spacing of Signs

  Yes

  No

  N/A

• Condition of signs

  Yes

  No

  N/A

• Intersection(s) Signed

  Yes

  No

  N/A

Flagging

• Number & Location

  Yes

  No

  N/A

• Communications

  Yes

  No

  N/A

• Proper Devices Utilized

  Yes

  No

  N/A

• Proper Attire

  Yes

  No

  N/A

Lane Closure

• Proper Size Cone & Taper

  Yes

  No

  N/A

• Cone/ Barrel Spacing

  Yes

  No

  N/A

• TMA/ Shadow Vehicle

  Yes

  No

  N/A

• Buffer Zone

  Yes

  No

  N/A

• Arrow board(s)

  Yes

  No

  N/A

• Traffic Congestion

  Yes

  No

  N/A

Personal Safety Equipment

• Safety Vest/ Rain -suit

  Yes

  No

  N/A

• Hand Protection

  Yes

  No

  N/A

• Eye/Face protection

  Yes

  No

  N/A

• Hearing Protection

  Yes

  No

  N/A

• Head Protection

  Yes

  No

  N/A

• Fall protection

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Equipment/ Process

• Vehicles (Strobes,SMV,etc)

  Yes

  No

  N/A

• Pre-Trip completed

  Yes

  No

  N/A

• Hand Tools (shovels, etc)

  Yes

  No

  N/A

• Powered Tools (chainsaw, etc)

  Yes

  No

  N/A

• Trenching/ Shoring

  Yes

  No

  N/A

• OUPS Ticket

  Yes

  No

  N/A

More

• Other comments

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• Do you Agree with these findings?

  Yes

  No

  N/A

• On site representative

  Sign

• Auditor's signature

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