Title Page

  • Audit Title

  • Client / Site

  • Prepared by

  • Personnel

SIGNAGE

  • Haz Assessment Thoroughly Completed

  • Sign In

  • DOL Poster

  • KDC rules posted

  • MPN and map posted

  • Incident Reporting instructions posted

  • Emergency Evac

Public

  • Pedestrian / Public Protection Plan

Fall Protection/Prevention

  • Scissor lift safety and compliance

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

Scaffold Compliance

  • Scaffold Safety

  • Scaffold Permit

Trenching Excavation

  • Permit

  • Access Egress 4ft or >

  • Cave In Protection

  • Fall Protection 6ft or >

Electrical / Tools

  • Tool safety

  • Equipment safety

  • Electrical Safety - GFCI, Temp Power, Cords, Open Panels, LOTO

Ladders

  • Ladder Safety including manufacturing labels

  • Ladder usage and set up

Housekeeping

  • Housekeeping [Interior & Exterior]

  • Water in compliance with HIPP

  • Caught In-between/Struck By

  • Any trip and fall hazards

Safety Plans - Required Permits

  • Silica Mngt Plan

  • Hot Work Permit

  • Fall Protection Plan 15 or>

  • Scaffold Plan

  • Pedestrian Protection Plan (Signed)

  • Crane Plan

  • Fork/Boom Lift Certs

  • Powder Actuated Tool Lic

PPE

  • PPE Compliance - Z87.1, N95, N100, Hardhats, Gloves, Hearing P, Class II Vests

  • SWPPP ISSUES?

  • Dust Control

  • Add signature

  • Comments

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.