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 > or = to 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 Monitoring

  • Are noise mitigation measures in place where applicable

  • Are backup alarms community sensitive?

  • Issues found

  • Item
  • Description

  • Photos

  • Noise 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 properly managed?<br>

  • Is a NYCDEP discharge permit in place and are conditions met?(Flometer and pH readings)

  • 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 trash/debris respectables properly maintained?

  • 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 with date of last inspection?

  • 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.