NHPL Distribution Safety Audit

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

GENERAL (All work types)

• AED Inspection

  Yes

  No

  N/A

• JHA/Briefing Completed

  Yes

  No

  N/A

• Safe Temp Monitor

  Yes

  No

  N/A

• Traffic control equipment in place

  Yes

  No

  N/A

• Personal Protective Equipment used

  Yes

  No

  N/A

• Fire Extinguishers

  Yes

  No

  N/A

• Emergency Rescue Blocks

  Yes

  No

  N/A

• Certified First Aid/CPR

  Yes

  No

  N/A

• First Aid Kit is Stocked

  Yes

  No

  N/A

• Emergency Contact is Displayed

  Yes

  No

  N/A

• Outriggers/Pads used

  Yes

  No

  N/A

• GFCI Utilized

  Yes

  No

  N/A

• Competent Person on Site

  Yes

  No

  N/A

• Qualified Workers

  Yes

  No

  N/A

• Operators Trained

  Yes

  No

  N/A

• Drinking Water/Cups on Site

  Yes

  No

  N/A

• Safety Cans Utilized/Labeled

  Yes

  No

  N/A

• Housekeeping

  Yes

  No

  N/A

• Seatbelts Utilized

  Yes

  No

  N/A

Excavation/Trenching/Shoring

• Soil Classified

  Yes

  No

  N/A

• Trench Inspected

  Yes

  No

  N/A

• Ladders/Ramps In Place

  Yes

  No

  N/A

• Trench Box

  Yes

  No

  N/A

• Sloping/Benching/Shoring (Adequate)

  Yes

  No

  N/A

• Spoil piles 2 Foot Back

  Yes

  No

  N/A

• Underground Facilities Marked

  Yes

  No

  N/A

Confined Space Program

• Monitor On Site

  Yes

  No

  N/A

• Permit on Site

  Yes

  No

  N/A

• Air Pump Utilized

  Yes

  No

  N/A

• Rescue Equipment On Site

  Yes

  No

  N/A

Electrical

• Fire Retardant Clothes

  Yes

  No

  N/A

• Protective Cover-up Installed

  Yes

  No

  N/A

• Rubber Cover (Condition)

  Yes

  No

  N/A

• Rubber Gloves and Sleeves

  Yes

  No

  N/A

• Gloves/Sleeves Test Dates

  Yes

  No

  N/A

• Grounds (Condition)

  Yes

  No

  N/A

• Hot Sticks (Condition)

  Yes

  No

  N/A

• One Shot Utilized

  Yes

  No

  N/A

• Minimum Approach Distance Maintained

  Yes

  No

  N/A

• System de-energized/tested/grounded

  Yes

  No

  N/A

• EPZ Utilized

  Yes

  No

  N/A

Fall Protection

• Harness/Lanyards Utilized

  Yes

  No

  N/A

• 100% Fall Arrest Utilized

  Yes

  No

  N/A

Lifting And Rigging

• Winch Rope Line Condition

  Yes

  No

  N/A

• Bucket Winch Rope

  Yes

  No

  N/A

• Turn Table (Any Boom Type)

  Yes

  No

  N/A

• Bucket/Inserts (Condition)

  Yes

  No

  N/A

• Boom (Condition)

  Yes

  No

  N/A

• Sheaves (Condition)

  Yes

  No

  N/A

• Machine Guards

  Yes

  No

  N/A

• Load Line/Hook Condition

  Yes

  No

  N/A

• Load Charts

  Yes

  No

  N/A

• Signal Charts

  Yes

  No

  N/A

• Tag Lines Utilized

  Yes

  No

  N/A

• Rope (Handline/Puller)

  Yes

  No

  N/A

• Slings/Clevises Condition

  Yes

  No

  N/A

• Lift Plan

  Yes

  No

  N/A

• Control Labeling

  Yes

  No

  N/A

Vehicle/DOT

• Drivers Log

  Yes

  No

  N/A

• DVIR Completed

  Yes

  No

  N/A

• Body Components Damaged

  Yes

  No

  N/A

• Proper Load Securement

  Yes

  No

  N/A

• DOT Inspection Good

  Yes

  No

  N/A

• Registration/Inspections Good

  Yes

  No

  N/A

Signatures

• Foreman

  Sign

• Safety Advisor

  Sign