Title Page

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • Select date

  • LCG
  • General
  • All LCG tags in place?

  • Material in good condition? (No significant deterioration, rust, splits in wood, frayed cable, etc.)

  • Entire hazard area protected? (No opening > 12" least dimension)

  • Guard essentially sound? (Shake or otherwise try to move guard and it should not move appreciably)

  • Hole Cover
  • Will withstand twice the potential load that could be applied to it? (Consider equipment movement in area)

  • Is secured in place?

  • Cover not more than 1" above walking surface? (Not tripping hazard)

  • Guardrails
  • Capable of at least 200 lb. outward or downward force?

  • 42" +/- 3" high? (Not deflected to < 39" when force is applied)

  • Mid rail midway between top rail and working/walking surface? (No openings greater than 19")

  • Max 8' centers between supports?

  • Surface is essentially smooth (to prevent cuts) and does not stick out to pose a hazard in walkways?

  • If used, bottom supports do not pose tripping hazards to workers in area?

  • The means to access the area is clear and a safe means of access is provided? (Gate, ladder, etc.)

  • If wore rope, flagged at not more than 6' intervals?

  • Comments:

  • LCG Inspector:

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