Jobsite Safety Survey

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Previous Jobsite Safety Survey

• Was previous survey reviewed?

  Yes

  No

  1st Visit

• Are there any outstanding items?

  Yes

  No

  Other

Personal Protective Equipment

• High-Visibility Vest/Other

  Yes

  No

  N/A

• Gloves

  Yes

  No

  N/A

• Hard Hat<br>

  Yes

  No

  N/A

• Safety Glasses

  Yes

  No

  N/A

Material Handling & Ergonomics

• Morning Stretching

  Yes

  No

  N/A

  At Risk
Equipment or Tools

• Add media

  Media

• Material Handling Aids/ tools condition

  Safe

  Repair

  At Risk

  N/A

Electrical

Overview of Our Electrical

• Proper Support for Cables

  Yes

  No

  N/A

  At Risk

• Enclosures Entact

  Yes

  No

  N/A

• GFCI Inspections Current

  Yes

  No

  N/A

• Spool Handling, tuggers, puller condition

  Safe

  Repair

  At Risk

  N/A

• Weather Protection

  Yes

  No

  N/A

  At Risk

• LOTO & Electrical Safe Work Practices

  Safe

  Repair

  At Risk

  N/A

• Cord & Cable Condition/ Open Splicing

  Safe

  Repair

  At Risk

  N/A

• Temporary Lighting

  Safe

  Repair

  At Risk

  N/A

Walking & Working Surfaces

• Mud, Water-Snow-Ice Removal

  Safe

  Repair

  At Risk

  N/A

• Housekeeping

  Safe

  At Risk

  N/A

Ladders

• Extension Ladders

  Yes

  No

  N/A

  At Risk

• Stepladders

  Yes

  No

  N/A

  At Risk

Fall Protection

• Multi Level or Roof Work Taking Place
6' Or More Fall exposure Assessment

• Add media

  Media

• Guardrails/Toeboards

  Safe

  Repair

  At Risk

  N/A

• Roof Flagging

  Safe

  Repair

  At Risk

  N/A

• Floor Openings I.e covers and floor access

  Safe

  Repair

  At Risk

  N/A

• Personal Fall Arrest Equipment Condition/Proper Use

  Safe

  Repair

  At Risk

  N/A

Fire Protection

• Emergency Plan In Place

  Yes

  No

  N/A

  At Risk

• Fire Extinguishers

  Yes

  No

  N/A

  At Risk

• Live Sprinklers?

  Live

  No

Employee Health

• Yes
Site Conditions

• Add media

  Media

• Dust Control/Dust Masks

  Safe

  Repair

  At Risk

  N/A

• Wet Concrete Cutting & Boring

  Yes

  No

  N/A

• Proper Clean Up of Slurry

  Yes

  No

  N/A

• Sanitation

  Yes

  No

  N/A

  At Risk

• Fireproofing Clean Up

  Safe

  Repair

  At Risk

  N/A

• Air Condition I.e C.O, welding

  Safe

  At Risk

  N/A

• PACM Survey & Procedures

  Yes

  No

  N/A

  At Risk

Scaffolding and Lifts

• Annual inspection (lifts only).

  Yes

  No

  N/A

• Chains/gates closed

  Yes

  No

  N/A

• Other concerns regarding the lifts.

  Safe

  Repair

  At Risk

  N/A

• Scaffolding In Use
Set Up

• Access

  Yes

  No

  N/A

  At Risk

• Proper footing, level, feet, screw jacks ect...

  Safe

  Repair

  At Risk

  N/A

• Guardrails and decking complete on working level

  Safe

  Repair

  At Risk

  N/A

• Diagonal brace on rolling scaffold

  Yes

  No

  N/A

• Inspected

  Yes

  No

  N/A

  At Risk

Excavations

• Yes
Overview of Trench or Excavation

• Add media

  Media

• Proper Slope, Shore, fracturing, water accumulation, ect...

  Safe

  Repair

  At Risk

  N/A

• Egress within 25 Feet, ladder usage.

  Yes

  No

  N/A

• Air Concerns

  Yes

  No

  N/A

  At Risk

Cranes & Rigging

• Yes
Process overview

• Add media

  Media

• Loads Properly Controlled

  Yes

  No

  N/A

  At Risk

• Rigging condition

  Yes

  No

  N/A

  At Risk

• Sling Condition & Storage

  Safe

  Repair

  At Risk

  N/A

Employee Safety Contacts

• Name & Comments:

  Positive Feedback

  Coaching

  Employee Safety Violation

• Name & Comments:

  Positive Feedback

  Coaching

  Employee Safety Violation

• Other

  Safe

  Repair

  At Risk

  N/A