Title Page

  • Job No

  • Audit Title

  • Client / Site

  • Prepared by

  • Personnel

  • Add location

SIGNAGE

  • Haz Assessment Thoroughly Completed

  • DOL Poster

  • KDC Banner

  • KDC rules posted

  • MPN and map posted

  • Incident Reporting instructions posted

  • Heat illness prevention posters

  • Emergency Evac & Sign In Sheets

  • Tailgate Meeting Current

Public

  • Pedestrian / Public Protection Plan

  • Duty To Warn, Duty To Protect & Duty To Control

  • Pedestrian protection fencing

  • Public protection access egress

Fall Protection/Prevention

  • Scissor lift safety and compliance

  • Fall protection if exposed to a free fall six feet or more

  • PFAS Inspected

Scaffold Compliance

  • Scaffold Safety

  • Scaffold Permit

  • Guardrails

  • Tipping Restraint at 14in

  • Base Plates, Mudsills, Planking and Green Tag

Trenching Excavation

  • Permit

  • Soil Type identified by competent person

  • Cave In Protection

  • Fall Protection > 6ft

  • Spoil Piles

  • Tool safety including electrical cords and guards

  • Electrical cords extension cords GFCI

Ladders

  • Ladder Safety including manufacturing labels

  • Brackets

  • Rungs

  • Ladder usage and set up

  • Housekeeping

  • FOCUS FOUR - electrical caught in between struck by fall protection

  • Any trip and fall hazards

  • SWPPP ISSUES?

Safety Plans - Required Permits

  • Trenching >5ft

  • Fall Protection > 15ft

  • Scaffold Plan

  • Silica Awareness Plan

  • Hot Work Permit

  • Dust Control

PPE

  • Hard Hats

  • Vests

  • ANZI Z87.1

  • Hand Protection Correct for task

  • Hearing Protection

  • Respiratory Protection

  • Silica Exposure

  • Silica Exposure Plan Completed

  • Equipment safety

  • Water in compliance with HIPP

  • Machinery equipment tool certifications

  • Safety Non-Compliance

  • Add signature

  • Add signature

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.