NATE Site Safety Audit Form

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Self Support

• Guyed

• Monopole

• Rooftop

• Water Tank

• Other

• Describe Other:

• Scope of Work:

PART 1: JOB SITE DOCUMENTATION

• A. Was a Job Hazard Analysis conducted, form completed and on site?

  Yes

  No

  N/A

• B. Are the applicable safety signs posted?

  Yes

  No

  N/A

• C. Is there a competent person on site?

  Yes

  No

  N/A

• D. Is someone on site certified in First Aid / CPR / BBP?

  Yes

  No

  N/A

• E. Has the emergency data form been filled out and posted?

  Yes

  No

  N/A

• F. Has a site-specific emergency rescue plan been developed and documented?

  Yes

  No

  N/A

• G. Is there a documented procedure for any overhead electrical hazards?

  Yes

  No

  N/A

• H. Are the MSDS's available for the materials being used on site?

  Yes

  No

  N/A

• I. Was a tailgate meeting held to review the scope of today's work, relevant safety issues, and provide tower climbers with am opportunity to provide input, raise questions, and participate in safety-related discussions as they pertain to work on this site?

  Yes

  No

  N/A

PART 2: JOB SITE CONDITIONS (INCLUDE ENVIRONMENTALS)

• A. Is the work site clean of trash?

  Yes

  No

  N/A

• B. Are materials stored properly and orderly?

  Yes

  No

  N/A

• C. Are measures taken to prevent access by unauthorized personnel to the site?

  Yes

  No

  N/A

• D. Are areas barricaded as required?

  Yes

  No

  N/A

• E. Is drinking water available?

  Yes

  No

  N/A

• F. Are chemicals, flammable and combustible liquids stored properly? (i.e., No plastic gas cans)

  Yes

  No

  N/A

• G. Are fire extinguishers of the appropriate size and type available, and current inspection tags?

  Yes

  No

  N/A

• H. Are plant and animal hazards addressed and documented?

  Yes

  No

  N/A

PART 3: PPE

• A. Are employees wearing hard hats?

  Yes

  No

  N/A

• B. Are employees wearing proper work boots?

  Yes

  No

  N/A

• C. Are safety glasses being used? (if applicable)

  Yes

  No

  N/A

• D. Are employees wearing gloves? (if applicable)

  Yes

  No

  N/A

• E. Are employees dressed in appropriate work clothing?

  Yes

  No

  N/A

• F. Is hearing protection being used? (if applicable)

  Yes

  No

  N/A

PART 4: FALL PROTECTION EQUIPMENT

• A. Do employees that are exposed to falls, have documented training?

  Yes

  No

  N/A

• B. Is fall protection equipment being inspected daily and documented?

  Yes

  No

  N/A

• C. Are all fall protection equipment tags legible?

  Yes

  No

  N/A

• D. If the work being performed requires fall protection, is it being used 100%?

  Yes

  No

  N/A

• E. Is the proper equipment available on site to complete the task?

  Yes

  No

  N/A

PART 5: RF

• A. Have RF hazards been considered? (if applicable)

  Yes

  No

  N/A

• B. Is there a procedure in place to reduce the RF exposure within statutory limits? (if applicable)

  Yes

  No

  N/A

PART 6: HOISTS

• A. Are daily inspections being completed with documentation on site?

  Yes

  No

  N/A

• B. Is the hoist operator qualified? (Certified through training or qualified through experience)

  Yes

  No

  N/A

• C. Are load charts posted and readily available to hoist operator?

  Yes

  No

  N/A

• D. Is there an operator's manual for the unit on site?

  Yes

  No

  N/A

• E. are headache ball markings legible?

  Yes

  No

  N/A

• F. Is end connection properly secured?

  Yes

  No

  N/A

• G. Are all hoists secured and properly anchored for the load intended?

  Yes

  No

  N/A

• H. Are hoist controls clearly identified?

  Yes

  No

  N/A

• I. Are hoist controls easily accessible to the operator?

  Yes

  No

  N/A

• J. Is the hour meter operational and functioning properly?

  Yes

  No

  N/A

• K. Are tow-way radios being tested daily, if being used?

  Yes

  No

  N/A

• L. Are all exposed moving parts properly guarded?

  Yes

  No

  N/A

• M. Is a hand signal chart posted and visible to all personnel on site?

  Yes

  No

  N/A

PART 7: PERSONNEL LIFTING

• A. Is the hoist approved for lifting personnel?

  Yes

  No

  N/A

• B. has a pre-lift meeting been held, documented and made available on site?

  Yes

  No

  N/A

• C. In the pre-lift plan, was the trial lift completed and documented?

  Yes

  No

  N/A

• D. If a personnel platform is on site, does it have an identification plate with the proper data in place? (Proper data includes: weight of the platform, maximum intended load, and employee capacity)

  Yes

  No

  N/A

• E. If a gin pole is being used, does it have a load chart?

  Yes

  No

  N/A

PART 8: RIGGING & BLOCKING

• A. Are proper rigging practices being utilized?

  Yes

  No

  N/A

• B. Is rigging equipment in good condition?

  Yes

  No

  N/A

• C. Are the tags on synthetic slings legible?

  Yes

  No

  N/A

• D. Is rigging equipment being inspected daily and the inspection documented?

  Yes

  No

  N/A

• E. Are tag lines in good condition?

  Yes

  No

  N/A

PART 9: GIN POLES

• A. Is gin pole rigging in good condition? (if visible)

  Yes

  No

  N/A

• B. Does the gin pole have an identification tag? (if visible)

  Yes

  No

  N/A

• C. Is the gin pole pre-job inspection form completed and on site or readily available?

  Yes

  No

  N/A

• D. Does the sheave in the rooster head match the wire rope? (if visible)

  Yes

  No

  N/A

PART 10: LADDERS

• A. Are units well maintained and in good working order?

  Yes

  No

  N/A

• B. Are ladders at the proper slope? (4:1 ratio)

  Yes

  No

  N/A

• C. Does the ladder extend 36 inches past the landing?

  Yes

  No

  N/A

• D. Is the ladder stable, on good ground?

  Yes

  No

  N/A

• E. Is the ladder set up correctly?

  Yes

  No

  N/A

PART 11: WORKER INVOLVEMENT

• A. Are daily tailgate meetings held on site with climbers to review the scope of the day's work, discuss relevant safety-related issues, and provide climbers the opportunity to provide input and ask questions?

  Yes

  No

  N/A

• B. Are climbers aware of the potential hazards and how to protect themselves?

  Yes

  No

  N/A

• C. Is there a procedure in place for climbers to report and correct identified hazards without fear of repercussions?

  Yes

  No

  N/A

• D. Did a competent person ensure that fall protection equipment was inspected prior to each use for damage, defect, or other deterioration by employees who have been trained in accordance with applicable standards?

  Yes

  No

  N/A

• E. if personnel hoisting is to be conducted, was an on site pre-lift meeting held with climbers and documented?

  Yes

  No

  N/A

PART 12: COMMENTS

PART 13: OVERALL IMPRESSION OF VISIT

• OUTSTANDING

• ABOVE AVERAGE

• AVERAGE

• BELOW AVERAGE

• Amount of time spent on this site visit:

• Necessary to follow up with written documentation?

  Yes

  No

• If any deficiencies were they corrected immediately?

  Yes

  No

  N/A

• Comments:

• This report was reviewed with:

  Supervisor

  Crew

  Both

• Auditors Signature:

  Sign

• Supervisors Signature:

  Sign

• Select date

  Date

DIRECTOR DEFICIENCY COMPLIANCE REPORT

• ITEM #

• Compliance completed by:

• Noted deficiency:

• Course of action:

• ITEM #

• Compliance completed by:

• Noted deficiency:

• Course of action:

• ITEM #

• Compliance completed by:

• Noted deficiency:

• Course of action:

• ITEM #

• Compliance completed by:

• Noted deficiency:

• Course of action: