KISS (Keep It Short & Sweet) AUDIT FORM

• Job Number

• Job Name

• Address
  Address

• Foreman On Site

• Conducted on

  Date

• Performed By

• Employees Present

Health & Safety Manual and Foreman’s Manual

• Are the Health & Safety Manual and Foreman’s Manual on site and/or in truck in convenient location?

  Yes

  No

  N/A

• Does everyone know the location of the Health & Safety Manual?

  Yes

  No

  N/A

• Comments/Corrections

MSDS Binder

• Is the MSDS on site and/or in truck in convenient location?

  Yes

  No

  N/A

• Does everyone know the location?

  Yes

  No

  N/A

• Comments/Corrections

Claims Reporting Packets

• Are they on site and/or in truck in convenient location?

  Yes

  No

  N/A

• Comments/Corrections

First Aid Kit

• On site and/or in truck in a convenient location?

  Yes

  No

  N/A

• Does everyone know the location?

  Yes

  No

  N/A

• Are all items within their expiration dates?

  Yes

  No

  N/A

• Comments/Corrections

Fire Protection

• Fire extinguisher on site?

  Yes

  No

  N/A

• Are charge and inspection date in compliance?

  Yes

  No

  N/A

• Comments/Corrections

MEDCOR

• Are stickers visible, preferably on inside bill of hard hat? (800) 775-5866.

  Yes

  No

  N/A

• Do all employees have the MEDCOR number programmed into their phones?

  Yes

  No

  N/A

• Comments/Corrections

Stretching

• Were stretching exercises conducted prior to commencing work?

  Yes

  No

  N/A

• Comments/Corrections

Storage of WSFP Material

• Are all materials neat and in order?

  Yes

  No

  N/A

• Is good housekeeping being maintained with minimal scrap material around power machine?

  Yes

  No

  N/A

• Are carts being utilized for the transportation of materials where possible?

  Yes

  No

  N/A

• Comments/Corrections

Personal Protective Equipment (PPE)

• Are hard hats, safety glasses and all appropriate safety equipment being worn by all?

  Yes

  No

  N/A

• Are face shields being worn while drilling overhead?

  Yes

  No

  N/A

• Comments/Corrections

Electrical Inspection

• All cords in good condition? (Includes extension, power machine, grounding pins, cord insulation, GFCI, scissor lift control box, etc.)

  Yes

  No

  N/A

• Have cord inspections been documented?

  Yes

  No

  N/A

• Comments/Corrections

Ladder Inspection

• Are all ladders in good condition? (Includes stickers, no modifications to side rails and top cap, crew working safely from them w/ 3 points of contact.)

  Yes

  No

  N/A

• Comments/Corrections

Equipment Inspection

• Are daily aerial lift and forklift inspections are being conducted?

  Yes

  No

  N/A

• Is documentation available?

  Yes

  No

  N/A

• Comments/Corrections

Fall Protection

• Are holes properly covered, secured and labeled?

  Yes

  No

  N/A

• Guardrails appear to be in place and in working condition?

  Yes

  No

  N/A

• Comments/Corrections

Lean Trucks

• Materials stored neat and in order with no trash build up? . Weekly vehicle inspection completed. Would you feel comfortable giving Gene Postma a ride?

  Safe

  At Risk

  N/A

• Is the truck properly stocked to avoid unnecessary fuel costs?

  Yes

  No

  N/A

• Would you feel comfortable giving Jeff Daane a ride?

  Yes

  No

  N/A

• Comments/Corrections

Vic Couplings & CPVC Joints

• Have all couplings been initialed indicating that they have been inspected for proper installation?

  Yes

  No

  N/A

• Have all CPVC fittings been initialed indicating that they have been inspected to prevent dry fits?

  Yes

  No

  N/A

Daily AHA Card

• Are WSFP activity hazard analysis cards being completed prior to beginning work?

  Yes

  No

  N/A

Hard Hat Expiration Date

• Are hard hats being worn?

  Yes

  No

  N/A

• Are all hard hats within the 5 year expiration period?

  Yes

  No

  N/A

• Are all hard hat liners within the 2 year expiration?

  Yes

  No

  N/A

Lock Out Tag Out (LOTO)

• Are all personnel familiar with the lock out tag out policy and the importance of strictly following it?

  Yes

  No

  N/A

• Are all the locks assigned to foreman accounted for?

  Yes

  No

  N/A

Tool Box Topic

• Did all employees know the tool box topic for the week?

  Yes

  No

  N/A

Signatures

• Auditors Signature

  Sign

• Foremans Signature

  Sign