Information
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Audit Title (Daily Weekly Monthly)
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Job Site Number
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Audit Date
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Prepared by
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Location (Street Area City)
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Superintendant
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Employeee(s)
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Weather (Temperature)
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Heat Index
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Today's JSA reviewed,complete understood & signed by all employees
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Why isn't the JSA completed?
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Traffic Control Signage Displayed per MUTCD
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Underground utilities marked/identified before digging?
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Warning vests or highly visible clothing worn by employees?
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Who or Why are they not being worn?
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Employees wearing appropriate PPE? Ex. Hard hats, safety glasses, gloves, boots etc
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Which Employees
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First Aid Kits on job-sites?
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Fire Extinguisher on all Motorized equipment & in Operational condition
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Fuel Tanks Properly Labeled?
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What did the competent person classify soil?
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Is there Silica controls being used?
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Open Excavations Inspected returning from Lunch or after Rain?
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Excavations/trenches over 5' deep proper sloping applied, or trench box used?
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If trench boxes are used, is tabulated data on site?
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Workers, working within trench box at all times?
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Spoil piles at least 2' away from edges of cut?
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Ladders placed within 25' of workers?
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Properly excavated ramp for egress? (employees able to walk upright )
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Back-up alarms functioning on all equipment?
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What Equipment, and has it been reported to the Shop?
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Is Heavy Equipment in Operation, have lights operational, and mud free from under pedals?
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Seat Belts Worn by Operators
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What Employee was not wearing seatbelt and why?
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Any Slip, Trips or Fall hazards?
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What was hazard
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Is there electrical equipment being used?
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Is the Electrical Cord free from damage and connected to a GFCCI?
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Any Miscellaneous unsafe work practices?
Replacement PPE & Equipment / Training Topic
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Was PPE was issued?
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What PPE was issued, and the quantity
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Any other items issued?
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What was issued?
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Was Training conducted during Safety Audit?
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What topic was covered?
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