Job Site Safety Survey

• Document No.

• Safety Worksite Audit

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Date:

  Date

• Site Location: (Ex: SM or Brazos)

• Location Description: (Ex: Kitchen, Smokehouse, etc.)

• Shift 1 or 2

• Inspected By:

Housekeeping

• Appearance of job neat & orderly<br>CFR 1926.26(a,b,c)

  Safe

  At Risk

  N/A

• Regular disposal of waste & trash<br>CFR 1926.26(a)

  Safe

  At Risk

  N/A

• Passageways & walkways clear of slip, trip, fall hazards<br>CFR 1925.26(a)

  Safe

  At Risk

  N/A

• All mechanical safeguards in place<br>CFR 1926.300(b)(1)

  Safe

  At Risk

  N/A

• Damaged tools repaired or replaced<br>CFR 1926.300(a) & 301(a)

  Safe

  At Risk

  N/A

Ladders and Stairs

• Proper signage posted for stairs? (Ex: “watch your step” “use hand rail”)

  Yes

  No

  N/A

• Do not use top step (Ladders)<br>CFR 1926.1053(b)(13)

  Safe

  At Risk

  N/A

• Portable ladders extended 3ft above upper landing<br>CFR 1926.1053(b)(1)

  Safe

  At Risk

  N/A

• Stepladders being used properly<br>CFR 1926.1053(b)(4)

  Safe

  At Risk

  N/A

• Damaged ladder?<br>CFR 1926.1053(b)(15)

  Safe

  At Risk

  N/A

Fire Protection

• Are fire exit signs posted?

  Yes

  No

  N/A

• Are all fire extinguishers up to date on inspections and tags?

  Yes

  No

  N/A

• Proper #, locations & access of fire extinguishers<br>CFR 1926.150(a)(2)

  Safe

  At Risk

  N/A

• Periodic inspections & maintenance<br>CFR 1926.150(c)(viii)

  Safe

  At Risk

  N/A

• Use of approved containers for flammable liquids<br>CFR 1926.152(a)(1)

  Safe

  At Risk

  N/A

PIT Equipment (Powered Industrial Trucks) (Ex: Forklifts, Pallet Jacks, etc.)

• Head, hand, Eye, Feet & hearing protection used<br>CFR 1926.300(c)

  Yes

  No

  N/A

• Back-up alarms or flagman<br>CFR 1926.601(b)(4)(i) & (ii)

  Safe

  At Risk

  N/A

• Seat belts<br>CFR 1926.601(b)(9)

  Safe

  At Risk

  N/A

• Roll-over Protective structures<br>CFR 1926.1001(a)

  Safe

  At Risk

  N/A

• Fire extinguishers on PIT?

  Safe

  At Risk

  N/A

• Horn<br>CFR 1926.602(a)(9)(i)

  Safe

  At Risk

  N/A

• Does the Driver have an authorization card to operate the P.I.T?

  Yes

  No

  N/A

Personal Protection

• Head, hand, Eye, Feet & hearing protection used<br>CFR 1926.300(c)

  Yes

  No

  N/A

• Hard hat/ Bump Cap<br>CFR 1926.100(a,b,c) & ANSI Z89.1-1969 & Z89.2-1971

  Safe

  At Risk

  N/A

Electrical

• LO/TO Program in effect<br>CFR 1926.417(a) thru (c)

  Safe

  At Risk

  N/A

Material Handling

• Material stacked, racked, etc.<br>CFR 1926.250(a)(1)

  Safe

  At Risk

  N/A

• Are hallways or fire exit doors unobstructed and clear from materials?

  Yes

  No

  N/A

• Non compatible fluids segregated<br>CFR 1926.250(b)(3)

  Safe

  At Risk

  N/A

Environmental Issues

• Is the SDS accessible to all team members?

  Yes

  No

  N/A

Ergonomics

• Are team members using proper ergonomics for task being conducted?

  Yes

  No

  N/A

Hand Tools

• Are hand tools being inspected for damage?

  Yes

  No

  N/A

• Are sharp cutting utensils and objects being used in a safe manner?

  Yes

  No

  N/A

Inventory

• AED charged?

  Yes

  No

  N/A

• First Aid Kits stocked?

  Yes

  No

  N/A