Information

  • Name and Address of Project
  • Name of Team Leader

  • # of Employees

  • Date Audit Performed

  • Prepared by

1.0 Fall Protection (Warning Line)

  • 1.1 Line 34-39 inches above working surface.

  • 1.2 Flagging every six (6) feet.

  • 1.3 Stands can Withstand 16 lbs. of Tipping Force.

  • 1.4 Rope is Stronger than 500 lbs. Tensile Strength.

  • 1.5 Warning Line 6 - 10 Feet Away from Fall Hazards.

  • 1.6 Fall Arrest, Fall Restraint, or Safety Monitor Used for Work Outside Warning Line.

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  • 1.7 Fall Arrest or Restraint (Max 25 Points)

2.0 Fixed Stairs

  • 2.1 Fixed Stairs

  • Fixed Stair Max (20 points)

3.0 Fixed Ladder

  • 3.1 Fixed Ladder

  • 3.2 Secured to Wall or Structure

  • 3.3 Safe to Climb

  • 3.4 Fixed Ladder (10 Points Max)

4.0 Extension Ladder

  • 4.1 Extension Ladder Used

  • 4.2 Has inspection tag.

  • 4.3 Missing, bent, or broken parts

  • 4.4 Missing fly rope.

  • 4.5 3 ft. above landing or eave.

  • 4.6 Secured at top.

  • 4.7 Secured at bottom.

  • 4.8 Extension Ladder (10 Max Points)

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5.0 PPE

  • 5.1 Hearing Protection Required for Loud Noises.

  • 5.2 Hard Hat worn for overhead hazards and work.

  • 5.3 Longs Pants Required for Hot Work

  • 5.4 Long Sleeved Shirt Required for Hot Work

  • 5.5 Respirator Required.

  • 5.6 Safety Glasses

  • 5.7 Worn for tear off.

  • 5.8 Worn for other eye hazards.

  • 5.9 PPE worn correctly.

  • 5.0 Personal Protective Equipment (PPE) (5 Points Max)

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6.0 Electrical

  • 6.1 Electrical Used.

  • 6.2 Wires inspected.

  • 6.3 GFCI Used for Temporary Power Sources.

  • 6.4 Work Remains 20 feet Away from Electrical Lines

  • 6.5 Covers Required for Electrical Lines.

  • 6.6 Electrical (5 Points Max)

7.0 Material Hoisting

  • 7.1 Trash Chute or Hoisting Used for Elevated Projects (20 feet or more)

  • 7.2 Pallets Not Stacked More than 2 High

8.0 Cranes

  • 8.1 Crane Used.

  • 8.2 Crane Operator Trained.

  • 8.3 Signal Person Trained and Communicates with Operator.

  • 8.4 Sling tag available and serviceable for use.

  • 8.5 Overhead Work Signs Posted near Hoisting Area(s).

  • 8.6 Flagging or Warning Lines Around Crane and Lift Area.

  • 8.7 Taglines Used for Material or Equipment Control.

  • 8.8 Crane Inspection Performed

  • 8.9 Hoisting (5 Points Max)

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9.0 Fire Prevention

  • 9.1 Extinguishers within 25 - 50 feet of Work.

  • 9.2 Used / Spent Extinguishers removed from Project or Site.

  • 9.3 Gas Cans Labeled and Stored.

  • 9.4 Screen Located Within Gas Cans.

  • 9.5 Fire Prevention (5 Points Max)

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10.0 Forklift

  • 10.1 Forklift Used.

  • 10.2 Forklift Operator Trained.

  • 10.3 Daily Inspection Performed.

  • 10.4 Rigger Trained and Communicates with Operator.

  • 10.5 Signal Person Trained and Communicates with Operator.

11.0 General Liability

  • 11.1 Nails Bent or Removed from Boards.

  • 11.2 Roof Tie-in Performed Daily.

  • 11.3 Plugs Removed from Drains.

  • 11.4 Work logged Daily in a Journal.

  • 11.5 Site or Project Inspected for Previous Damage.

  • 11.6 Caution Signs Posted.

  • 11.7 General Liability (5 Points Max)

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12.0 Emergency Readiness

  • 12.1 First Aid Kit (with Eye Wash Bottle) On-Site and Available to Employees.

  • 12.2 HAZCOM Manual On-Site and Available to Employees.

  • 12.3 Safety Manual On-Site and Available to Employees.

  • 12.4 Emergency Readiness (5 Points Max)

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13.0 Scaffold.

  • 13.1 Scaffold Required

  • 13.2 Scaffold has Hoist for Materials.

  • 13.3 Access Secured at Night.

  • 13.4 Inspected by Competent Person.

  • 13.5 Scaffold has Green Tag for Use.

  • 13.6 Scaffold is level.

  • 13.7 4:1 Ratio and Tied to Building (Push / Pull)

  • 13.8 Walk Boards Bent.

  • 13.9 Scaffold (5 Points Max)

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14.0 Safety Talks

  • 14.1 Performed Weekly, Signed & Turned In

  • Safety Talks (5 Points Max)

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.