Title Page

  • Job No

  • Audit Title

  • Client / Site

  • Prepared by

  • Personnel

  • Add location

SIGNAGE

  • Haz Assessment Thoroughly Completed

  • KDC HSE and SDS on phone

  • MPN Location

  • Incident Reporting Instruction Understood

  • Heat Illness SOP if Applicable

Public

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

  • Public protection access egress

Fall Protection/Prevention

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

  • PFAS Inspected

  • 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

  • Fall Protection > 15ft

  • 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

  • Machinery equipment tool certifications

  • Safety Non-Compliance

  • Current registration insurance and claims information

  • Vehicle walk around prior to operation

  • Cleanliness of Van

  • Driving skills

  • 1st aid kit readily accessible

  • Fire extinguisher readily accessible

  • Clean company logo shirt with name ballcap

  • 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.