Title Page
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Audit Title
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Client / Site
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Prepared by
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Personnel
SIGNAGE
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Haz Assessment Thoroughly Completed
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Sign In
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DOL Poster
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KDC rules posted
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MPN and map posted
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Incident Reporting instructions posted
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Emergency Evac
Public
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Pedestrian / Public Protection Plan
Fall Protection/Prevention
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Scissor lift safety and compliance
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Fall protection if exposed to a free fall six feet or more
Scaffold Compliance
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Scaffold Safety
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Scaffold Permit
Trenching Excavation
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Access Egress 4ft or >
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Cave In Protection
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Fall Protection 6ft or >
Electrical / Tools
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Tool safety
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Equipment safety
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Electrical Safety - GFCI, Temp Power, Cords, Open Panels, LOTO
Ladders
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Ladder Safety including manufacturing labels
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Ladder usage and set up
Housekeeping
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Housekeeping [Interior & Exterior]
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Water in compliance with HIPP
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Caught In-between/Struck By
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Any trip and fall hazards
Safety Plans - Required Permits
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Silica Mngt Plan
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Demo Plan
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Hot Work Permit
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Scaffold Plan
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Rolling Scaffold Plan
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Pedestrian Protection Plan (Signed)
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Crane Plan
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Trenching Plan
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Fork/Boom Lift Certs
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Powder Actuated Tool Lic
PPE
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PPE Compliance - Z87.1, N95, N100, Hardhats, Gloves, Hearing P, Class II Vests
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SWPPP ISSUES?
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Dust Control
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Sanitation
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Notes/Commeny
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Signature
