KISS Site Safety Audit

• Document No.

• Job Name

• Department

• Foreman

• Conducted on

  Date

• Audited by

• Location
  Address

Administrative

• Health and Safety Manual Onsite

  Yes

  No

  N/A

• MSDS Notebook Onsite

  Yes

  No

  N/A

• Claims Packet Onsite

  Yes

  No

  N/A

• Medcor Programmed into all Company Phones. Stickers on Hardhats / Toolbox<br>1-800-775-5866

  Yes

  No

  N/A

• Weekly Toolbox Talk Complete

  Yes

  No

  N/A

• First Aid Kit Onsite

  Yes

  No

  N/A

• Date First Aid Kit Expires

  Date

• Fire Extinguishers Available Onsite

  Yes

  No

  N/A

• Hot Work Permit Completed

  Yes

  No

  N/A

• Daily Huddle completed and documented

  Yes

  No

  N/A

• Aerial Lift / Forklift inspection complete and documented

  Yes

  No

  N/A

• Stretching routine completed before work start

  Yes

  No

  N/A

• Lean Trucks - Are you proud of the appearance of your truck?

  Yes

  No

  N/A

PPE

• Hardhats, Safety Glasses and Work boots worn by all employees

  Yes

  No

  N/A

• Additional PPE Worn / Available

Electrical

• Electrical cords are in good condition

  Yes

  No

  N/A

• Cords are tested and taped per the assured grounding policy, section 11.2 of the Health and Safety Manual

  Yes

  No

  N/A

• GFCI is used at the electrical source

  Yes

  No

  N/A

Fall Protection and Fall Prevention

• Harnesses & Lanyards stored properly when not in use

  Yes

  No

  N/A

• Anchor Points provided or approved anchor point device in use

  Yes

  No

  N/A

• Holes created by WSFP covered or filled

  Yes

  No

  N/A

• Guardrails in good condition

  Yes

  No

  N/A

• Work performed from aerial lifts is conducted safely

  Yes

  No

  N/A

Ladders

• Ladders are in good condition

  Yes

  No

  N/A

• Ladder stickers (maximum load, OSHA safety stickers) are legible

  Yes

  No

  N/A

• Work performed from ladders is being performed safely

  Yes

  No

  N/A

Material Handling & Storage

• Good Housekeeping in WSFP lay-down area

  Yes

  No

  N/A

• Carts in use

  Yes

  No

  N/A

• Rigging / Slings in good condition

  Yes

  No

  N/A

• Material Stored neatly and in order out of the way of traffic

  Yes

  No

  N/A

• Forklift Operator operates the forklift safely

  Yes

  No

  N/A

• Hand tools are in good condition. No cheater bars or cracked handles.

  Yes

  No

  N/A

Saves / Near Miss Incidents

• Describe the incident or any lesson learned

• Date of Save / Near Miss

  Date

General Jobsite Comments

• Comments

• Field knows to NEVER WORK ON A LIVE SYSTEM and TRUST BUT VERIFY

  Yes

  No

  N/A

Pre-Job Risk Management

• Sure Off Tester is Available and Foreman knows how to use them

  Yes

  No

  N/A

• Signed Contract or Agreement in place

  Yes

  No

  N/A

• Pre-authorization Signature signed

  Yes

  No

  N/A

• Control Valve is shut

  Yes

  No

  N/A

• Main Drain is open

  Yes

  No

  N/A

• Trapped Water is drained

  Yes

  No

  N/A

• Owners product in work area is removed or protected

  Yes

  No

  N/A

• Plastic in use

  Yes

  No

  N/A

Post-Job Risk Management - reviewed / discussed with the crew Onsite

• Test with air before introducing water

  Yes

  No

  N/A

• Turn on water in small increments and check work area for leaks

  Yes

  No

  N/A

• Obtain second signature on service work ticket

  Yes

  No

  N/A

• Circle system either in service or out of service

  Yes

  No

  N/A

• If "out of service" notify the owner/ owners representative, use Deactivation Authorization and notify the proper authorities

  Yes

  No

  N/A

• Clean up work area

  Yes

  No

  N/A