Information
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
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Self Support
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Guyed
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Monopole
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Rooftop
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Water Tank
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Other
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Describe Other:
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Scope of Work:
PART 1: JOB SITE DOCUMENTATION
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A. Was a Job Hazard Analysis conducted, form completed and on site?
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B. Are the applicable safety signs posted?
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C. Is there a competent person on site?
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Designated by company, able to recognize hazards, ability to stop work for correction of hazards.
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D. Is someone on site certified in First Aid / CPR / BBP?
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E. Has the emergency data form been filled out and posted?
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F. Has a site-specific emergency rescue plan been developed and documented?
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G. Is there a documented procedure for any overhead electrical hazards?
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H. Are the MSDS's available for the materials being used on site?
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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)
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A. Is the work site clean of trash?
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B. Are materials stored properly and orderly?
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C. Are measures taken to prevent access by unauthorized personnel to the site?
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D. Are areas barricaded as required?
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E. Is drinking water available?
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F. Are chemicals, flammable and combustible liquids stored properly? (i.e., No plastic gas cans)
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G. Are fire extinguishers of the appropriate size and type available, and current inspection tags?
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H. Are plant and animal hazards addressed and documented?
PART 3: PPE
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A. Are employees wearing hard hats?
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B. Are employees wearing proper work boots?
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C. Are safety glasses being used? (if applicable)
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D. Are employees wearing gloves? (if applicable)
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E. Are employees dressed in appropriate work clothing?
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F. Is hearing protection being used? (if applicable)
PART 4: FALL PROTECTION EQUIPMENT
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A. Do employees that are exposed to falls, have documented training?
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B. Is fall protection equipment being inspected daily and documented?
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C. Are all fall protection equipment tags legible?
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D. If the work being performed requires fall protection, is it being used 100%?
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E. Is the proper equipment available on site to complete the task?
PART 5: RF
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A. Have RF hazards been considered? (if applicable)
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B. Is there a procedure in place to reduce the RF exposure within statutory limits? (if applicable)
PART 6: HOISTS
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A. Are daily inspections being completed with documentation on site?
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B. Is the hoist operator qualified? (Certified through training or qualified through experience)
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C. Are load charts posted and readily available to hoist operator?
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D. Is there an operator's manual for the unit on site?
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E. are headache ball markings legible?
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F. Is end connection properly secured?
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G. Are all hoists secured and properly anchored for the load intended?
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H. Are hoist controls clearly identified?
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I. Are hoist controls easily accessible to the operator?
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J. Is the hour meter operational and functioning properly?
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K. Are tow-way radios being tested daily, if being used?
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L. Are all exposed moving parts properly guarded?
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M. Is a hand signal chart posted and visible to all personnel on site?
PART 7: PERSONNEL LIFTING
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A. Is the hoist approved for lifting personnel?
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B. has a pre-lift meeting been held, documented and made available on site?
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C. In the pre-lift plan, was the trial lift completed and documented?
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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)
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E. If a gin pole is being used, does it have a load chart?
PART 8: RIGGING & BLOCKING
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A. Are proper rigging practices being utilized?
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B. Is rigging equipment in good condition?
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C. Are the tags on synthetic slings legible?
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D. Is rigging equipment being inspected daily and the inspection documented?
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E. Are tag lines in good condition?
PART 9: GIN POLES
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A. Is gin pole rigging in good condition? (if visible)
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B. Does the gin pole have an identification tag? (if visible)
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C. Is the gin pole pre-job inspection form completed and on site or readily available?
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D. Does the sheave in the rooster head match the wire rope? (if visible)
PART 10: LADDERS
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A. Are units well maintained and in good working order?
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B. Are ladders at the proper slope? (4:1 ratio)
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C. Does the ladder extend 36 inches past the landing?
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D. Is the ladder stable, on good ground?
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E. Is the ladder set up correctly?
PART 11: WORKER INVOLVEMENT
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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?
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B. Are climbers aware of the potential hazards and how to protect themselves?
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C. Is there a procedure in place for climbers to report and correct identified hazards without fear of repercussions?
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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?
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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
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OUTSTANDING
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ABOVE AVERAGE
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AVERAGE
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BELOW AVERAGE
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Amount of time spent on this site visit:
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Necessary to follow up with written documentation?
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If any deficiencies were they corrected immediately?
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Comments:
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This report was reviewed with:
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Auditors Signature:
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Supervisors Signature:
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Select date
DIRECTOR DEFICIENCY COMPLIANCE REPORT
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ITEM #
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Compliance completed by:
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Noted deficiency:
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Course of action:
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ITEM #
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Compliance completed by:
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Noted deficiency:
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Course of action:
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ITEM #
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Compliance completed by:
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Noted deficiency:
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Course of action:
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ITEM #
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Compliance completed by:
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Noted deficiency:
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Course of action: