Information
-
Document No.
-
Audit Title
-
Client / Site
-
Conducted on
-
Prepared by
-
Location
-
Personnel
GENERAL (All work types)
-
AED Inspection
-
JHA/Briefing Completed
-
Safe Temp Monitor
-
Traffic control equipment in place
-
Personal Protective Equipment used
-
Fire Extinguishers
-
Emergency Rescue Blocks
-
Certified First Aid/CPR
-
First Aid Kit is Stocked
-
Emergency Contact is Displayed
-
Outriggers/Pads used
-
GFCI Utilized
-
Competent Person on Site
-
Qualified Workers
-
Operators Trained
-
Drinking Water/Cups on Site
-
Safety Cans Utilized/Labeled
-
Housekeeping
-
Seatbelts Utilized
Excavation/Trenching/Shoring
-
Soil Classified
-
Trench Inspected
-
Ladders/Ramps In Place
-
Trench Box
-
Sloping/Benching/Shoring (Adequate)
-
Spoil piles 2 Foot Back
-
Underground Facilities Marked
Confined Space Program
-
Monitor On Site
-
Permit on Site
-
Air Pump Utilized
-
Rescue Equipment On Site
Electrical
-
Fire Retardant Clothes
-
Protective Cover-up Installed
-
Rubber Cover (Condition)
-
Rubber Gloves and Sleeves
-
Gloves/Sleeves Test Dates
-
Grounds (Condition)
-
Hot Sticks (Condition)
-
One Shot Utilized
-
Minimum Approach Distance Maintained
-
System de-energized/tested/grounded
-
EPZ Utilized
Fall Protection
-
Harness/Lanyards Utilized
-
100% Fall Arrest Utilized
Lifting And Rigging
-
Winch Rope Line Condition
-
Bucket Winch Rope
-
Turn Table (Any Boom Type)
-
Bucket/Inserts (Condition)
-
Boom (Condition)
-
Sheaves (Condition)
-
Machine Guards
-
Load Line/Hook Condition
-
Load Charts
-
Signal Charts
-
Tag Lines Utilized
-
Rope (Handline/Puller)
-
Slings/Clevises Condition
-
Lift Plan
-
Control Labeling
Vehicle/DOT
-
Drivers Log
-
DVIR Completed
-
Body Components Damaged
-
Proper Load Securement
-
DOT Inspection Good
-
Registration/Inspections Good
Signatures
-
Foreman
-
Safety Advisor
