NextEdge Safety Audit Form

A. Was a Pre-Job Hazard Assessment (JHA) conducted, form complete and on-site?

B. Are there applicable safety signs posted?

C. Is there a competent person on site?

D. Is there more than one person (minimum of 2) on site certified in First Aid/CPR/BBP/AED

E. Per ANSI/ASSP A10.48 has the emergency data form been filled out and posted?

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

G. Are SDS, available for the material being used on the jobsite? (Available via digital means and methods acceptable)?

H. If a rigging plan is required, does the approved rigging plan correspond with the on-site conditions?

I. Is the proper equipment to complete the task on the jobsite?

J. Are daily tailgate meetings held to review the scope of work?

K. Before commencing climbing or rigging operations, has the structure owner or NATE guidelines for dig-to-block been evaluated by the competent person?

L. Is there a stop work authority procedure in place for personnel to report and correct identified hazards without fear of repercussions?

A. Are the housekeeping responsibilities met and maintained?

B. Are the materials stored properly and orderly?

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

D. Are areas barricaded as required?<br>

E. Is adequate drinking water available for all members of the crew?

F. Are chemical, flammable and combustible liquids stored properly? (i.e. no plastic gas cans)

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

H. Are plant and animal hazards addressed and documented?

A. Are employees wearing head protection?

B. Are employees wearing proper footwear?

C. Is approved eye protection being used?<br>

D. Are employees wearing appropriate gloves when required?

E. Are employees dressed in appropriate work clothing?

F. Are employees wearing appropriate hearing protection when required?

G. Are employees wearing appropriate high-visibility clothing when required?

A. Do personnel exposed to falls have documented training?

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

C. Is the proper fall protection equipment on the jobsite to perform the scope of work?

D. Is a documented fall protection plan readily available on the jobsite?

E. Is a documented rescue plan readily available on the jobsite?

F. Are personnel utilizing 100% tie-off practices?

A. Do personnel exposed to RF have documented training?

B. Have RF hazards been documented?

C. Is a documented RF plan readily available on the jobsite?

D. Are personal RF monitors being worn?

E. Are RF monitors calibrated and charged?

A. Are daily inspections being completed with documentation on the jobsite?

B. Is the hoist operator qualified per ANSI/ASSP A10.48?

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

D. Is there an operator manual for the unit on the jobsite?

E. Are overhaul ball markings legible?

F. Is end termination properly secured?

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

H. Has hoist load test(s) been performed per scope of work?

I. Are hoist controls clearly identified?

J. Are hoist controls easily accessible to the operator?

K. Is the hour meter operational and functioning properly?

L. Are non-trunked, dedicated frequency two-way radios being tested daily, if being used?

M. Are all exposed moving parts properly guarded?

N. Is a hand signal chart readily available on the jobsite?

A. Is the hoist approved for lifting personnel (man-rated)?

B. Has a pre-lift meeting been held, documented, and made available on the jobsite?

C. Was a trial lift completed and documented?

D. If a personnel platform is on site, does it have an identification plate with weight ofthe platform, maximum intended load, and employee capacity?

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

A. Are all tags on rigging equipment legible?

B. Has rigging equipment been inspected per ANSI/ASSP A10.48?

C. Have all load lines been inspected?

D. Have all tag lines been inspected?<br>

E. Have all blocks been inspected?

F. Have all shackles, hooks, and hardware been inspected?<br>

G. Have all slings been inspected?

A. Has the gin pole been inspected per ANSI/ASSP A10.48?

B. Have the rigging components and accessories used with the gin pole been inspected?

C. Does the gin pole have identification markings?

D. Has the gin pole been assembled per the load chart?

E. Does the sheave in the rooster head / block, match the D/d wire rope size?

F. Has a trial lift been preformed and documented?

G. Has an approved Class 4 rigging plan been established on the jobsite?

A. Is the climbing path clear of obstruction?

B. Is there a safety climb system available?

C. Does the safety climb system pass inspection?

D. Are portable ladders at the proper slope? (4:1 ratio)

E. Is the portable ladder secured, stable, and on level ground?

F. Does the extension ladder extend 36 inches past landing?

A. Do personnel exposed to electrical hazards have documented training?

B. Based on the scope of work, are the personnel trained on the Lockout/Tagoutprocedures?

C. Are electrical panels covered when not being worked on?

D. Are Ground Fault Circuit Interrupters (GFCI) being used if permanent wiring isnot available?

E. Are extension cords in good condition?

F. Are the correct length and gauge of extension cords being utilized?

G. If necessary, has the power company been notified?<br>

H. Is there a documented procedure for site-specific electrical hazards that relates tothe scope of work?

A. Has the lift plan been completed as per OSHA 1926.1400 subpart CC and reviewed with all personnel on site?

B. Is there a documented procedure for site-specific electrical hazards that relates to the lift plan?

C. Is crane operator certified?<br>

D. Does the signal person have documented training?

E. Have the operator and signal person established a communication method?

F. Is the annual inspection tag or inspection report current, and readily available?

G. Are load charts readily available?

H. Are cranes cribbed and level?

I. Is the block or overhaul (headache) ball properly marked?

J. Is end termination properly secured?

K. Have the daily crane and rigging inspections been conducted and documented?

L. Is a hand signal chart readily available on the jobsite?

M. Have any known underground conditions been verified?

A. Does the operator have documented training?

B. Is there a documented procedure for site-specific electrical hazards that relates to theconstruction plan?

C. Has the capstan hoist and mounting system been inspected and documented?

D. Are operator controls in good working condition? (Foot Pedal or Switch)

E. Is rope of sufficient size, strength and type for load being lifted?

F. Is the manufacturer's labeling indicating load rating legible?

G. Is the capstan drum free of corrosion and grooves?

H. Have the vehicle wheels been chocked?

A. Has a competent person been identified?

B. Has both private and public 811 (utility avoidance) been contacted prior to construction?

C. Have utilities (public and private) been marked?

D. During drilled shaft operations are fall protection systems in place?

E. Are systems in place to prevent fall hazards during operations?

F. Are all open excavations properly barricaded overnight?

G. Have personnel in the trench been properly protected from cave-in?

H. If personnel are in the trench is there proper entry and egress?

I. Have spoils been placed at a minimum of two feet from the excavation edge?

A. Is back-up alarm working properly?

B. Is roll-over protection installed and in good condition?

C. Are safety interlocks operational?

D. Are hazard lights working properly?

E. Are buckets and booms free of cracks and defects?

F. Are personnel clear of the danger area or working radius?

G. Have all the daily inspections required in the operator's manual been performed and documented?

H. Have all operators been properly trained on safe use and operation of the unit being used?

A. Are all tools in good condition?

B. Are electrical tools properly grounded or double insulated?

C. Are proper guards in place?

D. Are all tools being used for intended purpose of the manufacturer?

A. Is CDL valid for equipment being used?<br>

B. Do drivers have DOT Medical Card (greater than 10,001 lbs GVW)?

C. Are drivers Electronic Logging Devices (ELD) current?

D. Are Daily Vehicle Inspection Reports (DVIR) current?

E. Is vehicle labeled per DOT requirements?

F. Are emergency reflectors in the vehicle?

G. Is vehicle interior / exterior maintained properly?

H. Is there any interior or exterior damage?

I. Is the windshield in good condition?

J. Are tires in good condition?

K. Are fire extinguisher(s) of appropriate size and rating readily available and equipped with a current monthly inspection tag?

L. Is the fire extinguisher location identified?

M. Is a DOT compliant first aid kit located on the vehicle?

N. Are all state & federal inspection stickers current?

O. Is the insurance and registration certificate current and readily available?

P. Are all exterior lights in operational condition? (truck and trailer)

Q. Are trailer breakaway harnesses properly functioning?

R. Are trailer safety chains properly installed?

S. Is material secured in accordance with DOT regulations?

T. Are all fuel containers used properly?

Overall Impression

Necessary to follow up with written documentation?

If any deficiencies were they corrected immediately?

Was this report was reviewed with supervisor and crew?

Compliance Completed By