Midwest Service Group Safety Audit - Revised

• Name of Job

• Location
  Address

• Conducted on

  Date

• Crew Foreman

• Prepared by

PPE For Crew

• Eye protection being worn by entire crew?

  Yes

  No

  N/A

• Hard hats being worn by entire crew?

  Yes

  No

  N/A

• Hearing protection needed?

  Yes

  No

  N/A

• Hearing protection worn correctly?

  Yes

  No

  N/A

• Hearing protection adequate for noise exposure?

  Yes

  No

  N/A

• Hearing protection available on site?

  Yes

  No

  N/A

• Respiratory Protection in use?

  Yes

  No

  N/A

• Appropriate footwear being worn by entire crew?

  Yes

  No

  N/A

Site Safety

• Charged fire extinguisher available?

  Yes

  No

  N/A

• Complete first aid kits on site?

  Yes

  No

  N/A

• Is job site clean, neat, and organized?

  Yes

  No

  N/A

• Add an overview picture of the site.

  Media

General Safety

• Proper fall protection in use?

  Yes

  No

  N/A

• Are proper dust control procedures being followed?

  Yes

  No

  N/A

• Is containment air tight and negative air machines working properly?

  Yes

  No

  N/A

• Are tools serviceable and in good condition?

  Yes

  No

  N/A

• Are tools and equipment being used as intended?

  Yes

  No

  N/A

• Scaffoldolding properly assembled?

  Yes

  No

  N/A

• Wheels on scaffolds locked?

  Yes

  No

  N/A

• Are employees out from under suspended loads?

  Yes

  No

  N/A

Vehicles and Equipment

• Are company vehicles and equipment clean, neat, and organized?

  Yes

  No

  N/A

• Are company vehicles and equipment in safe working condition?

  Yes

  No

  N/A

• Seat belts used in all vehicles and equipment?

  Yes

  No

  N/A

• Are company procedures and guidelines being followed?

  Yes

  No

  N/A

General Comments

Confirmation

• Follow up items and deficiencies reviewed with crew?

• Inspector Signature

  Sign

• Foreman Signature

  Sign
Crew Signature

• Add signature

  Sign