Information

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • 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?

  • B. Are the applicable safety signs posted?

  • C. Is there a competent person on site?

  • Designated by company, able to recognize hazards, ability to stop work for correction of hazards.

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

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

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

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

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

  • 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?

PART 2: JOB SITE CONDITIONS (INCLUDE ENVIRONMENTALS)

  • A. Is the work site clean of trash?

  • B. Are materials stored properly and orderly?

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

  • D. Are areas barricaded as required?

  • E. Is drinking water available?

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

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

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

PART 3: PPE

  • A. Are employees wearing hard hats?

  • B. Are employees wearing proper work boots?

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

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

  • E. Are employees dressed in appropriate work clothing?

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

PART 4: FALL PROTECTION EQUIPMENT

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

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

  • C. Are all fall protection equipment tags legible?

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

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

PART 5: RF

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

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

PART 6: HOISTS

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

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

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

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

  • E. are headache ball markings legible?

  • F. Is end connection properly secured?

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

  • H. Are hoist controls clearly identified?

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

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

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

  • L. Are all exposed moving parts properly guarded?

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

PART 7: PERSONNEL LIFTING

  • A. Is the hoist approved for lifting personnel?

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

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

  • 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)

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

PART 8: RIGGING & BLOCKING

  • A. Are proper rigging practices being utilized?

  • B. Is rigging equipment in good condition?

  • C. Are the tags on synthetic slings legible?

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

  • E. Are tag lines in good condition?

PART 9: GIN POLES

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

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

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

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

PART 10: LADDERS

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

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

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

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

  • E. Is the ladder set up correctly?

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?

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

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

  • 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?

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

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?

  • If any deficiencies were they corrected immediately?

  • Comments:

  • This report was reviewed with:

  • Auditors Signature:

  • Supervisors Signature:

  • Select 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:

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