Jobsite Safety Survey

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Personnel

Previous Jobsite Safety Survey

• Was previous survey reviewed?

  Yes

  No

  N/A

• Are there any outstanding items?

  Yes

  No

  N/A

Personal Protective Equipment

• Hard Hat<br>

  Safe

  At Risk

  N/A

• Safety Glasses

  Safe

  At Risk

  N/A

• Gloves

  Safe

  At Risk

  N/A

• High-Visibility Vest

  Safe

  At Risk

  N/A

Material Handling & Ergonomics

• Morning Stretching Completed

  Yes

  No

  N/A

• Spool Handling

  Safe

  At Risk

  N/A

• Material Handling Aids

  Safe

  At Risk

  N/A

Electrical

• LOTO & Electrical Safe Work Practices

  Safe

  At Risk

  N/A

• Live Work Authorization - Review Results

  Safe

  At Risk

  N/A

• Enclosures Entact

  Yes

  No

  N/A

• Temporary Lighting

  Safe

  At Risk

  N/A

• GFCI Inspections Current

  Yes

  No

  N/A

• Proper Support for Cables

  Yes

  No

  N/A

• Temporary Splices Properly Executed

  Yes

  No

  N/A

• Cord & Cable Condition

  Safe

  At Risk

  N/A

• Weather Protection

  Safe

  At Risk

  N/A

Walking & Working Surfaces

• Housekeeping

  Safe

  At Risk

  N/A

• Water-Mud-Snow-Ice Removal

  Safe

  At Risk

  N/A

• Building Egress

  Safe

  At Risk

  N/A

• Other

  Safe

  At Risk

  N/A

Ladder Use

• Stepladders

  Safe

  At Risk

  N/A

• Extension Ladders

  Safe

  At Risk

  N/A

Boom and Scissors Lift Operations

• Safety Chains Used on Lifts

  Yes

  No

  N/A

• Pre-Shift Inspection Performed

  Yes

  No

  N/A

• Tied Off When Required

  Yes

  No

  N/A

• Annual Inpections Current

  Yes

  No

  N/A

Fall Protection

• Guardrails and Warning Lines

  Safe

  At Risk

  N/A

• Holes Covered

  Yes

  No

  N/A

• Personal Fall Arrest System

  Safe

  At Risk

  N/A

Fire Protection

• Fire Extinguishers

  Safe

  At Risk

  N/A

• Combustible Loads Managed

  Safe

  At Risk

  N/A

• Hot Work Procedures

  Safe

  At Risk

  N/A

• Are there live sprinkler heads on this job?

  Yes

  No

  N/A

Employee Health

• Sanitation

  Safe

  At Risk

  N/A

• Dust Control

  Safe

  At Risk

  N/A

• Fireproofing Clean Up

  Safe

  At Risk

  N/A

• Wet Concrete Cutting & Boring

  Yes

  No

  N/A

• Proper Clean Up of Slurry

  Yes

  No

  N/A

• Carbon Monoxide

  Safe

  At Risk

  N/A

• PACM Survey & Procedures

  Safe

  At Risk

  N/A

• Other

  Safe

  At Risk

  N/A

Scaffolding

• Inspected by Competent Person

  Yes

  No

  N/A

• Baseplates & Mudsills

  Safe

  At Risk

  N/A

• Guardrails

  Safe

  At Risk

  N/A

• Working Level Completely Decked

  Yes

  No

  N/A

• Diagonal Brace on Rolling Tower

  Yes

  No

  N/A

• Proper Access (Ladders & Stairs)

  Yes

  No

  N/A

• Miscellaneous (pins, wind clips, anchorage)

  Safe

  At Risk

  N/A

Excavations

• Proper Slope & Shore

  Yes

  No

  N/A

• Spoils Pile Set Back 2 Feet

  Yes

  No

  N/A

• Egress within 25 Feet

  Yes

  No

  N/A

• Ladder Use

  Safe

  At Risk

  N/A

• Daily Inspection by Competent Person

  Yes

  No

  N/A

Cranes & Rigging

• Crews Under Loads

  Safe

  At Risk

  N/A

• Loads Properly Controlled

  Yes

  No

  N/A

• Sling Condition & Storage

  Safe

  At Risk

  N/A

Miscellaneous

• Health & Safety

  Safe

  At Risk

  N/A

• Environmental

  Yes

  No

  N/A

• Other

  Safe

  At Risk

  N/A

Short Service Employee - Contacts

• Name & Comments:

  Positive Feedback

  Coaching

  Employee Safety Violation

• Name & Comments:

  Positive Feedback

  Coaching

  Employee Safety Violation

Employee Safety Contacts

• Name & Comments:

  Positive Feedback

  Coaching

  Employee Safety Violation

• Name & Comments:

  Positive Feedback

  Coaching

  Employee Safety Violation

• Name & Comments:

  Positive Feedback

  Coaching

  Employee Safety Violation