Keystone

• Audit Title

• Conducted on

  Date

• Project Manager

• Foreman

• Prepared by

• Location
  Address

Personal Protective Equipment

• Hard Hat

  Safe

  At Risk

  N/A

• Faceshield

  Yes

  No

  N/A

• Safety Glasses

  Safe

  At Risk

  N/A

• Gloves

  Safe

  At Risk

  N/A

• Respirators

  Yes

  No

  N/A

• High-Visibility Vest

  Safe

  At Risk

  N/A

• Avg noise level (dBa)

• Hearing protection provided?

  Yes

  No

  N/A

• Comments...

Material Handling & Ergonomics

• Material handling aids

  Safe

  At Risk

  N/A

• Forklifts used today?

• Operators trained

  Yes

  No

  N/A

• Inspections completed

  Yes

  No

  N/A

• Overall forklift operation

  Safe

  At Risk

  N/A

• Spotter Use and Position

  Yes

  No

  N/A

Tools

• Observed tool usage

  Safe

  At Risk

  N/A

Walking and working surfaces

• Housekeeping

  Safe

  At Risk

  N/A

• Access/egress

  Safe

  At Risk

  N/A

• Slip/trip/fall hazards

  Safe

  At Risk

  N/A

• Impalement hazards protected

  Yes

  No

  N/A

Working at Heights

• Stepladders

• Inspections current?

  Yes

  No

  N/A

• Proper setup/use?

  Yes

  No

  N/A

• Extension/straight ladders

• Inspections current?

  Yes

  No

  N/A

• Proper setup/use

  Yes

  No

  N/A

• Aerial lifts

• Operators trained

  Yes

  No

  N/A

• Daily inspection completed

  Yes

  No

  N/A

• 100% fall protection

  Yes

  No

  N/A

• AWP overall operation

  Yes

  No

  N/A

Fall protection

• Guardrails

  Safe

  At Risk

  N/A

• Holes covered

  Yes

  No

  N/A

• Personal fall arrest system

  Safe

  At Risk

  N/A

Fire protection

• Fire extinguishers

  Safe

  At Risk

  N/A

• Hot work procedures

  Safe

  At Risk

  N/A

Employee health

• Dust hazard

• Dust control

  Safe

  At Risk

  N/A

• Respirators used?

  Yes

  No

• Appendix D signed?

  Yes

  No

  N/A

• Sanitation

  Safe

  At Risk

  N/A

Electrical

• Temp Lighting

  Yes

  No

  N/A

• Employees have adequate lighting

  Yes

  No

  N/A

• Cords 7ft Off Ground

  Yes

  No

  N/A

• Green Equipment Verified Dead

  Yes

  No

  N/A

Other

• Scaffolding used on site?

• Inspected by competent person and tagged?

  Yes

  No

  N/A

• Guardrails

  Safe

  At Risk

  N/A

• Working level completely decked

  Yes

  No

  N/A

• Proper access (ladders & stairs)

  Yes

  No

  N/A

Summary

• Additional comments

• Additional photos

  Media

• Safety auditor signature

  Sign