Information
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
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Company
- MBS Houston
- MBS Dallas
- MBS San Antonio
- MBS Austin
- MISI Atlanta
- MEMCO CUSTOMER
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Name of Company
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Select date
Project Information
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Description
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General Contractor
- Gilbane
- D.E. Harvey
- Tellepsen
- Turner
- Skanska
- J.E. Dunn
- Brasfield & Gory
- Austin Commercial
- Vaughn
- Linbeck
- Other
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Enter Craft
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G.C. Name
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Type of Job
- Interior
- Exterior
- Interior & Exterior
- Remodel
- Maintenance
- General Industry
- Other
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Auditor
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Enter Name
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Marek Representative
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Craft
- Drywall
- Finisher
- Acoustical
- Painter
- Labor
- Other
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Enter Craft
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Enter Name
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Multiple Supervisors
Supervisor
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Name
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Craft
- Drywall
- Finisher
- Acoustical
- Painter
- Labor
- Other
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Number of Employees
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- Other
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Type number of employees
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OFL
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Reason
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Description
Administration
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Observations
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Project Safe
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HAZCOM
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Tool Box Talks
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Topic of the week
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Reason
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Both Languages
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Select
Housekeeping
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Observation
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Access & Exits
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Description
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Corridors & Hallways
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Description
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Material Properly Stored
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Description
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Trash Disposal
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Description
Equipment
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Observation
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Scaffolds
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Person Responsible
Employee
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Name
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Employee Number
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Safety Violation
- Fall Exposure
- Defective/Poor
- Incomplete
- Uncertified
- Leading Edge
- Opening/Hole
- Weather
- Inadequate Ventilation
- Inadequate Lighting
- Missing Guard
- Failure to Inspect
- Improper Use
- Modified Equipment
- Servicing Equipment
- Fail to remove from service
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Decision
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Stilts
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Person Responsible
Employee
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Name
-
Employee Number
-
Safety Violation
- Fall Exposure
- Defective/Poor
- Incomplete
- Uncertified
- Leading Edge
- Opening/Hole
- Weather
- Inadequate Ventilation
- Inadequate Lighting
- Missing Guard
- Failure to Inspect
- Improper Use
- Modified Equipment
- Servicing Equipment
- Fail to remove from service
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Decision
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Ladders
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Person Responsible
Employee
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Name
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Employee Number
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Safety Violation
- Fall Exposure
- Defective/Poor
- Incomplete
- Uncertified
- Leading Edge
- Opening/Hole
- Weather
- Inadequate Ventilation
- Inadequate Lighting
- Missing Guard
- Failure to Inspect
- Improper Use
- Modified Equipment
- Servicing Equipment
- Fail to remove from service
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Decision
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Elevated Working Platforms
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Person Responsible
Employee
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Name
-
Employee Number
-
Safety Violation
- Fall Exposure
- Defective/Poor
- Incomplete
- Uncertified
- Leading Edge
- Opening/Hole
- Weather
- Inadequate Ventilation
- Inadequate Lighting
- Missing Guard
- Failure to Inspect
- Improper Use
- Modified Equipment
- Servicing Equipment
- Fail to remove from service
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Decision
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Powder Actuated Tools
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Person Responsible
Employee
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Name
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Employee Number
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Safety Violation
- Fall Exposure
- Defective/Poor
- Incomplete
- Uncertified
- Leading Edge
- Opening/Hole
- Weather
- Inadequate Ventilation
- Inadequate Lighting
- Missing Guard
- Failure to Inspect
- Improper Use
- Modified Equipment
- Servicing Equipment
- Fail to remove from service
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Decision
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Laser
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Person Responsible
Employee
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Name
-
Employee Number
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Safety Violation
- Fall Exposure
- Defective/Poor
- Incomplete
- Uncertified
- Leading Edge
- Opening/Hole
- Weather
- Inadequate Ventilation
- Inadequate Lighting
- Missing Guard
- Failure to Inspect
- Improper Use
- Modified Equipment
- Servicing Equipment
- Fail to remove from service
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Decision
Tools
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Observation
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Hand tools
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Hand Tool
Tool
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Description
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Person Responsible
Employee
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Name
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Employee Number
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Power Tools
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Power Tool
Tool
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CX Number
PPE
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Observation
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Head Protection
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Description
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Ear Protection
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Description
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Eye Protection
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Description
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Face Protection
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Description
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Respiratory Protection
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Description
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Arm Protection
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Description
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Foot Protection
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Description
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Fall Protection
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Description
Emergency Prevention Program
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Observation
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Fire Extinguishers
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Evacuation Route Posted
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Hazard Analysis for sprinkles reviewed
Electrical
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Observation
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GFCI Available
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Electrical Cords Inspected
Traffic Control
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Observation
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Barricades in place
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Select
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Flagger
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Reflective Clothing
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Proper Signs
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Finalize Safety Audit
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Reviewed by
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Signature
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Completed by
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Signature
