Title Page

  • Document No.

  • Client / Site

  • Conducted on

  • Location
  • Auditor

  • Forman

  • Crew

  • Equipment

  • Are crew members wearing the required Personal Protective Gear?

  • Is the personal protective gear adequate for the job?

  • Are all personnel aware of the characteristics of the material?

  • Is Confined Space Entry required for this job?

  • Is Permit completed & posted

  • Is Gas Detector in place and operable?

  • Is Ventilation in place and operable?

  • Is full Body Harness properly worn?

  • Is Lifeline properly secured to harnes

  • Is a Tripod and Winch needed if vertical entry required?

  • Is the job setup Safely and Effective?

  • Are Barricades in place to keep job site protected?

  • Are Tripping/Slipping hazards minimized?

  • Is the job site kept free of trash and debris?

  • Is the proper equipment being used on the job?

  • Does the Forman have the tools to do the job?

  • Is the equipment properly maintained?

  • Has a Vehicle Inspection Sheet been completed?

  • Does any of the equipment need to be written up for repairs?

  • Are there any leaking fluids that be attended to?

  • Have steps been taken to contain any leaks?

  • Does the Operator have a spill kit available?

  • Are all percussion being taken to prevent spills or any other Environmental Damages?

  • Is the job being properly supervised?

  • What can be done to improve our job site performance?

  • What was discussed with the crew concerning safety and improving the job performance?

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