Information

  • Audit Title (Daily Weekly Monthly)

  • Job Site Number

  • Audit Date

  • Prepared by

  • Location (Street Area City)
  • Superintendant

  • Employeee(s)

  • Weather (Temperature)

  • Heat Index

  • Today's JSA reviewed,complete understood & signed by all employees

  • Why isn't the JSA completed?

  • Traffic Control Signage Displayed per MUTCD

  • Underground utilities marked/identified before digging?

  • Warning vests or highly visible clothing worn by employees?

  • Who or Why are they not being worn?

  • Employees wearing appropriate PPE? Ex. Hard hats, safety glasses, gloves, boots etc

  • Which Employees

  • First Aid Kits on job-sites?

  • Fire Extinguisher on all Motorized equipment & in Operational condition

  • Fuel Tanks Properly Labeled?

  • What did the competent person classify soil?

  • Is there Silica controls being used?

  • Open Excavations Inspected returning from Lunch or after Rain?

  • Excavations/trenches over 5' deep proper sloping applied, or trench box used?

  • If trench boxes are used, is tabulated data on site?

  • Workers, working within trench box at all times?

  • Spoil piles at least 2' away from edges of cut?

  • Ladders placed within 25' of workers?

  • Properly excavated ramp for egress? (employees able to walk upright )

  • Back-up alarms functioning on all equipment?

  • What Equipment, and has it been reported to the Shop?

  • Is Heavy Equipment in Operation, have lights operational, and mud free from under pedals?

  • Seat Belts Worn by Operators

  • What Employee was not wearing seatbelt and why?

  • Any Slip, Trips or Fall hazards?

  • What was hazard

  • Is there electrical equipment being used?

  • Is the Electrical Cord free from damage and connected to a GFCCI?

  • Any Miscellaneous unsafe work practices?

Replacement PPE & Equipment / Training Topic

  • Was PPE was issued?

  • What PPE was issued, and the quantity

  • Any other items issued?

  • What was issued?

  • Was Training conducted during Safety Audit?

  • What topic was covered?

  • Pictures upload here

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.