Information

  • Project

  • Quarter

  • Contract Number

  • Location
  • Attendees

  • Additional Attendees

  • Conducted on

  • Prepared by

  • Project Description

1.0 Air Quality

  • Are dust control methods being used, such as misting systems, dust boss, and ventilation to minimize dust being generated?

  • Is equipment >50 hp fitted with a DPF or other emission control device, or use a tier4 engine?

  • Are all pieces of equipment inventoried with an MTACC sticker?

  • Are Camp meters in place upwind and downwind of where the work is happening?

  • Issues Found

  • Item
  • Add media

  • Air Quality Score

2.0 Noise and Vibration

  • Are noise readings being taken for all pieces of equipment?

  • Are noise blankets, mufflers being used in loud areas?

  • Are backup alarms community sensitive?

  • Issues found

  • Item
  • Description

  • Photos

  • Noise and Vibration Score

3.0 Stormwater/ Erosion and Sediment Control/ Dewatering

  • Are all catch basins protected with filter fabric or other device?<br>

  • Is ground water being collected and managed with a NYC deposit permit? <br>

  • Are daily flows and pH being recorded?

  • Are stockpiles covered to minimize Sediment from leaving the work site?

  • Issues found

  • Item
  • Description

  • Photos

  • Stormwater and Erosion Control Score

4.0 Waste Management

  • Are spill/drip pans used under equipment such as cranes and pipe threaders?

  • Are raw materials stored on pallets and open materials stored on spill pallets?

  • Are all containers labeled with contents and waste drums/containers labeled properly?

  • Are roll off containers covered at the end of the shift?

  • Is used oil being generated?

  • Is the storage tank registered with the DEC?

  • Is used oil stored in drums?

  • Is the oil drum in secondary containment?

  • Issues found

  • Item
  • Description

  • Photos

  • Waste Management Score

5.0 Spill Prevention and Response

  • Are spill kits available and accessible?

  • Issues found

  • Item
  • Description

  • Photos

  • Spill Prevention and Response Score

6.0 General Site Conditions

  • Is housekeeping being performed and site generally clean?

  • Is standing water on site being addressed?

  • Is vector control in place?

  • Are boxes being labeled and maintained?

  • Issues found

  • Item
  • Description

  • Photos

  • General Site Conditions Score

Conclusion and auditor's comments

  • Date of audit completed

  • Signature of auditor

  • Date of auditor's signature

  • Signature of auditee

  • Date of auditee's signature

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.