Title Page
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Job No
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Audit Title
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Client / Site
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Prepared by
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Personnel
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Add location
SIGNAGE
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Haz Assessment Thoroughly Completed
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KDC HSE and SDS on phone
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MPN Location
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Incident Reporting Instruction Understood
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Heat Illness SOP if Applicable
Public
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Duty To Warn, Duty To Protect & Duty To Control
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Public protection access egress
Fall Protection/Prevention
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Fall protection if exposed to a free fall six feet or more
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PFAS Inspected
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Electrical cords extension cords GFCI
Ladders
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Ladder Safety including manufacturing labels
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Brackets
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Rungs
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Ladder usage and set up
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Housekeeping
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FOCUS FOUR - electrical caught in between struck by fall protection
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Any trip and fall hazards
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SWPPP ISSUES?
Safety Plans - Required Permits
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Fall Protection > 15ft
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Silica Awareness Plan
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Hot Work Permit
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Dust Control
PPE
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Hard Hats
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Vests
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ANZI Z87.1
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Hand Protection Correct for task
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Hearing Protection
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Respiratory Protection
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Silica Exposure
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Silica Exposure Plan Completed
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Equipment safety
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Machinery equipment tool certifications
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Safety Non-Compliance
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Add signature
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Current registration insurance and claims information
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Vehicle walk around prior to operation
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Cleanliness of Van
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Driving skills
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1st aid kit readily accessible
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Fire extinguisher readily accessible
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Clean company logo shirt with name ballcap