NorthStar - Project Safety Audit - 2019

• Project Number

• Project Name

• Project Supervisor

• Project Manager

• Client Name

• Conducted on

  Date

• Prepared by

• Crew Size

1.0 - ADMINISTRATIVE

• 1.0 - Administrative Audit

• 1.1 - Hazardous materials survey on site?

  Yes

  No

  N/A

• 1.1.1 - Has the survey been reviewed with the crew?

  Yes

  No

  N/A

• 1.1.2 - Is it easily accessible for the crew to review?

  Yes

  No

  N/A

• 1.1.3 - Are the crew asbestos awareness trained?

  Yes

  No

  N/A

• Identify the person who has been contacted to get a copy of the survey onto site. Once received, get confirmation from Supervisor that it has been reviewed and that it is easily accessible to the crew.

• 1.2 - Has a Site Specific Safety Plan (SSSP) been prepared?

  Yes

  No

  N/A

• 1.2.1 - Has it been reviewed with the crew?

  Yes

  No

  N/A

• Identify the people who haven't reviewed the SSSP.

• 1.3 - Are OSHA 300 Logs posted?

  Yes

  No

  N/A

• 1.4 - Are OSHA and State posters posted on site?

  Yes

  No

  N/A

2.0 - PROJECT COMMUNICATION

• 2.0 - Project Communication

• 2.1 - Has a Safety Meeting been completed within the last 7 days?

  Yes

  No

  N/A

• 2.1.1 - Is the Safety Meeting adequate for the work being performed on site?

  Yes

  No

  N/A

• 2.1.2 - Was a tool box/training topic discussed during the meeting?

  Yes

  No

  N/A

• Identify the topic.

• 2.1.3 - Has the entire crew attended the Safety Meeting?

  Yes

  No

  N/A

• List the people who didn't attend.

• 2.2 - Has a Daily Safety Huddle been performed for all tasks on site?

  Yes

  No

  N/A

• 2.3 - Has New Hire Orientation been completed with all new employees?

  Yes

  No

  N/A

• Identify missing employees:

3.0 - HAZARD IDENTIFICATION

• 3.0 - Hazard Identification

• 3.1 - On a scale of 1 to 10, have Pre-Tasks been completed for all current tasks?

• Which tasks are missing a pre-task plan?

• 3.2 - For the Pre-Tasks which HAVE BEEN completed, do they identify ALL known hazards and controls?

  Yes

  No

  N/A

• Name the hazards and/or controls which were missed.

• 3.3 - Have the Pre-Tasks been reviewed with ALL applicable employees?

  Yes

  No

  N/A

• Name the employees missed (and task).

• 3.4 - Are the controls identified in the pre-task plan being followed?

  Yes

  No

  N/A

4.0 - FIRST AID AND EMERGENCY RESPONSE

• 4.0 - First Aid and Emergency Response

• 4.1 - Does the supervisor have a current first aid card?

  Yes

  No

  N/A

• 4.2 - Are adequate first aid supplies on site?

  Yes

  No

  N/A

• 4.2.1 - Are the supplies stored in an easily accessible area?

  Yes

  No

  N/A

• 4.2.2 - Are the supplies being stored in a clean and organized manner?

  Yes

  No

  N/A

• 4.3 - Has an adequate emergency egress plan been developed?

  Yes

  No

  N/A

• 4.3.1 - After questioning a representative sample of employees, do you feel they have an understanding of what to do in the event of an emergency?

  Yes

  No

  N/A

• 4.4 - Is emergency egress route clear and well lit?

  Yes

  No

  N/A

5.0 - PERSONAL PROTECTIVE EQUIPMENT (INCLUDING PROPERLY WORN AND MAINTAINED)

• 5.0 - Personal Protective Equipment (Including Properly Worn and Maintained)

• 5.1 - Hard Hats

  Yes

  No

  N/A

• With a high score of 10, which score would you give for this policy being adequately enforced/followed?

• Name the employee(s) not wearing as required.

• 5.2 - Class II Vest

  Yes

  No

  N/A

• With a high score of 10, which score would you give for this policy being adequately enforced/followed?

• Name the employee(s) not wearing as required.

• 5.3 - Hi-Visibility Clothing

  Yes

  No

  N/A

• With a high score of 10, which score would you give for this policy being adequately enforced/followed?

• Name the employee(s) not wearing as required.

• 5.4 - Adequate Gloves

  Yes

  No

  N/A

• With a high score of 10, which score would you give for this policy being adequately enforced/followed?

• Name the employee(s) not wearing as required.

• 5.5 - Safety Boots

  Yes

  No

  N/A

• With a high score of 10, which score would you give for this policy being adequately enforced/followed?

• Name the employee(s) not wearing as required.

• 5.6 - Arm Guards

  Yes

  No

  N/A

• With a high score of 10, which score would you give for this policy being adequately enforced/followed?

• Name the employee(s) not wearing as required.

• 5.7 - Hearing Protection

  Yes

  No

  N/A

• With a high score of 10, which score would you give for this policy being adequately enforced/followed?

• Name the employee(s) not wearing as required.

• 5.8 - Safety Glasses

  Yes

  No

  N/A

• With a high score of 10, which score would you give for this policy being adequately enforced/followed?

• Name the employee(s) not wearing as required.

• 5.9 - Safety Goggles

  Yes

  No

  N/A

• With a high score of 10, which score would you give for this policy being adequately enforced/followed?

• Name the employee(s) not wearing as required.

• 5.10 - Face Shield

  Yes

  No

  N/A

• With a high score of 10, which score would you give for this policy being adequately enforced/followed?

• Name the employee(s) not wearing as required.

• 5.11 - Chainsaw Chaps

  Yes

  No

  N/A

• With a high score of 10, which score would you give for this policy being adequately enforced/followed?

• Name the employee(s) not wearing as required.

• 5.12 - Knee Pads

  Yes

  No

  N/A

• With a high score of 10, which score would you give for this policy being adequately enforced/followed?

• Name the employee(s) not wearing as required.

6.0 - HAZARD COMMUNICATION

• 6.1 - Are we using hazardous chemicals, as defined by the Hazard Communication Regulations?

• 6.1.1 - Are we maintaining a list of chemicals on site?

  Yes

  No

  N/A

• 6.1.2 - Do our employees have easy access to Safety Data Sheet?

  Yes

  No

  N/A

• 6.1.3 - Has the requirements of the Safety Data Sheet been reviewed with the crew?

  Yes

  No

  N/A

• 6.1.4 - Chemical being used safely (PPE, spill prevention, spill response)?

  Yes

  No

  N/A

• 6.1.5 - Are chemicals being stored safety?

  Yes

  No

  N/A

• 6.1.6 - Are employees trained in the new Hazard Communication (SDS) requirements?

  Yes

  No

  N/A

7.0 - HOUSEKEEPING AND LIGHTING

• 7.0 - Housekeeping and Lighting

• 7.1 - Are pathways clear throughout the project?

  Yes

  No

  N/A

• 7.2 - Have impalement hazards been removed?

  Yes

  No

  N/A

• 7.3 - Are equipment, tools, and materials being stored safely?

  Yes

  No

  N/A

• 7.4 - Is debris being managed safely?

  Yes

  No

  N/A

• 7.5 - Is adequate lighting available throughout our work area?

  Yes

  No

  N/A

8.0 - FIRE PREVENTION

• 8.0 - Fire Prevention

• 8.1 - Based on the work area size and hazards present, is adequate fire fighting equipment readily available?

  Yes

  No

  N/A

• 8.2 - Are fire extinguishers in good condition?

  Yes

  No

  N/A

• 8.3 - Have fire extinguisher inspection tags been completed?

  Yes

  No

  N/A

• 8.4 - Is a hot work permit required?

• 8.4.1 - Has it been completed and approved?

  Yes

  No

  N/A

• 8.4.2 - Is it adequate for the hot work task?

  Yes

  No

  N/A

• 8.4.3 - Is the Hot Work Permit located next to the hot work area?

  Yes

  No

  N/A

• 8.5 - Are flammable liquids being stored safely, in accordance with applicable regulations, i.e. quantities, cabinets, and containers?

  Yes

  No

  N/A

9.0 - FALL PROTECTION

• 9.0 - Fall Protection

• 9.1 - Are people being protected from falling onto dangerous equipment or debris piles?

  Yes

  No

  N/A

• 9.2 - Are fall hazards greater than 4 feet present?

• 9.2.1 - Have adequate guardrails been installed?

  Yes

  No

  N/A

• 9.2.2 - Have warning lines been installed?

  Yes

  No

  N/A

• 9.2.2(a) - Have warning lines been installed 15-feet back from unprotected edge inside the building?

  Yes

  No

  N/A

• 9.2.2(b) - Have warning lines been installed 6-feet back from unprotected roof edge?

  Yes

  No

  N/A

• 9.2.2(c) - Is rope, or similar strength material, being used for warning line?

  Yes

  No

  N/A

• 9.2.2(d) - Are warning lines flagged at least every 6-feet?

  Yes

  No

  N/A

• 9.2.2(e) - Are warning lines installed in a manner that prevents sagging below 36-inches?

  Yes

  No

  N/A

• 9.2.3 - Have floor holes or floor openings been adequately protected/isolated?

  Yes

  No

  N/A

• 9.3 - Is fall restraint or fall arrest equipment being used?

• 9.3.1 - Has a fall protection plan been prepared?

  Yes

  No

  N/A

• 9.3.1(a) - Does it clearly identify the scope of work and fall hazards present?

  Yes

  No

  N/A

• 9.3.1(b) - Does it clearly identify the type of fall arrest/restraint equipment to be used for the specific hazard?

  Yes

  No

  N/A

• 9.3.1(c) - Does it clearly identify how and where the anchor point will be set up?

  Yes

  No

  N/A

• 9.3.1(d) - Does it clearly identify how we will protect other trades/employees who will pass through or under out work area?

  Yes

  No

  N/A

• 9.3.1(e) - Does it identify an appropriate rescue plan?

  Yes

  No

  N/A

• 9.3.1(f) - Is the fall protection plan being followed?

  Yes

  No

  N/A

• 9.3.1(g) - Has the fall protection plan been reviewed with everyone associated with the fall hazard?

  Yes

  No

  N/A

• 9.3.2 - Is fall protection equipment being worn properly?

  Yes

  No

  N/A

• 9.3.3 - Has fall protection equipment been inspected?

  Yes

  No

  N/A

• 9.3.4 - Is the selected anchor point strong enough?

  Yes

  No

  N/A

• 9.3.5 - Is the anchor point in the correct position?

  Yes

  No

  N/A

• 9.3.6 - Is lanyard adequate for fall hazard and height?

  Yes

  No

  N/A

• 9.3.7 - Are crews fall protection trained?

  Yes

  No

  N/A

• 9.3.8 - Is fall protection equipment being stored safety when not in use?

  Yes

  No

  N/A

10.0 - USING MOBILE EQUIPMENT

• 10.0 - Using Mobile Equipment

• 10.1 - Are operators competent?

  Yes

  No

  N/A

• Identify the operator(s) and equipment which need training.

• 10.2 - Has equipment been inspected today?

  Yes

  No

  N/A

• Identify the operator(s) and equipment not inspected.

• 10.3 - Is equipment being operated on suspended slab?

• 10.3.1 - Has engineering been performed to confirm equipment use on suspended slab?

  Yes

  No

  N/A

• 10.3.2 - Are the limitations on the engineers calculations (distance between machines, weight limits etc.) being followed?

  Yes

  No

  N/A

• 10.4 - Is work area safe for the operation of equipment (housekeeping, delineated, other trades, spotter, flagger)?

  Yes

  No

  N/A

• 10.5 - Is equipment being operated safely?

  Yes

  No

  N/A

• 10.6 - Is the equipment operating next to an unprotected edge?

• 10.6.1 - Are unprotected edge hazards identified and controlled (cable, signage, wheel stop etc)?

  Yes

  No

  N/A

• 10.6.2 - Is the method of protecting the equipment sufficient?

  Yes

  No

  N/A

11.0 - ELECTRICAL

• 11.0 - Electrical

• 11.1 - Electrical equipment and cords in good condition?

  Yes

  No

  N/A

• 11.2 - Proper GFCI being used?

  Yes

  No

  N/A

• 11.3 - Are cords and equipment being properly protected from damage?

  Yes

  No

  N/A

12.0 - HAND TOOLS (POWERED AND NON-POWERED)

• 12.0 - Hand Tools (Powered and Non-Powered)

• 12.1 - Is tool in good condition (clean, decals etc)?

  Yes

  No

  N/A

• 12.2 - Is the tool the correct tool for the task?

  Yes

  No

  N/A

• 12.3 - Is the tool being used properly?

  Yes

  No

  N/A

• 12.4 - Is the operator competent?

  Yes

  No

  N/A

13.0 - ASBESTOS ABATEMENT

• 13.0 - Asbestos Abatement

• Is asbestos abatement being performed on this project?

13.1 - Competency

• 13.1.1 - Is the project being supervised by a licensed asbestos abatement supervisor?

  Yes

  No

  N/A

• 13.1.2 - Are the asbestos workers licensed/certified?

  Yes

  No

  N/A

13.2 - Medical Clearance

• 13.2.1 - Are asbestos medical clearances current for all abatement personnel on site?

  Yes

  No

  N/A

• 13.2.2 - Are respiratory medical clearances current for all abatement personnel on site?

  Yes

  No

  N/A

13.3 - Respirator Use, Maintenance, and Fit Testing

• 13.3.1 - Are asbestos personnel fit tested (within last 12 months) for the type of respirators being worn?

  Yes

  No

  N/A

• 13.3.2 - Are respirators being cleaned as required?

  Yes

  No

  N/A

13.4 - Asbestos Monitoring (Personal, Area, etc)

• 13.4.1 - Has comparable pre-abatement sampling been performed for indoor abatement operations?

  Yes

  No

  N/A

• 13.4.2 - Has representative and sufficient personal exposure monitoring been performed for asbestos operations?

  Yes

  No

  N/A

• 13.4.3 - Has outside work area monitoring been performed daily (other trades working adjacent to regulated area) or every other day when no other trades are present?

  Yes

  No

  N/A

• 13.4.4 - Has monitoring been performed at the exhaust of the negative air machine (every other day)?

  Yes

  No

  N/A

• 13.4.5 - For those regulated areas cleared, was the clearance obtained from same location as pre-abatement, and did it meet applicable clearance limits?

  Yes

  No

  N/A

13.5 - Work Controls (All Classes)

• 13.5.1 - Have the work areas been regulated using appropriate signage/banner tape?

  Yes

  No

  N/A

• 13.5.2 - Are vacuums HEPA filtered?

  Yes

  No

  N/A

• 13.5.3 - Are appropriate wet methods being used?

  Yes

  No

  N/A

13.6 - Decontamination

• 13.6.1 - Is an appropriate change area set up for abatement activities?

  Yes

  No

  N/A

• 13.6.2 - Does the abatement work require a shower to be provided?

• 13.6.2(a) - Has a working shower (warm water, shampoo, etc.) been set up?

  Yes

  No

  N/A

• 13.6.2(b) - Is shower water being filtered to at least 5 microns?

  Yes

  No

  N/A

• 13.6.3 - Are equipment/"dirty" room/area set up properly?

  Yes

  No

  N/A

• 13.6.4 - Are equipment/"dirty" room/areas being used properly?

  Yes

  No

  N/A

• 13.6.5 - Are personnel following the required decontamination processes?

  Yes

  No

  N/A

13.7 - Class I Asbestos Abatement

• 13.7.1 - Is Class I abatement being performed?

• 13.7.1(a) - Have critical barriers been installed over ALL openings to the regulated area?

  Yes

  No

  N/A

• 13.7.1(b) - Have fixed objects inside the regulated area been covered and protected to prevent contamination?

  Yes

  No

  N/A

• 13.7.1(c) - Have floor surfaces been protected with poly?

  Yes

  No

  N/A

• 13.7.1(d) - Does the negative pressure enclosure maintain at least 4 air changes per hour?

  Yes

  No

  N/A

• 13.7.1(e) - Do manometer records show we are maintaining a minimum of -0.02 column inches of pressure differential, relative to outside pressure?

  Yes

  No

  N/A

• 13.7.1(f) - Is the alarm set to be audible?

  Yes

  No

  N/A

• 13.7.1(g) - Is air flow within the negative pressure enclosure being directed away from ALL employees within the enclosure, and toward the HEPA filtered negative air machines?

  Yes

  No

  N/A

• 13.7.1(h) - Do supervisor records show evidence of daily enclosure inspections (prior to the start of each shift)?

  Yes

  No

  N/A

13.8 - Class II Asbestos Abatement

• 13.8.1 - Is Class II asbestos abatement being performed?

• 13.8.1(a) - Is material being removed intact?

  Yes

  No

  N/A

• 13.8.1(b) - Is material being kept wet, especially at point of contact?

  Yes

  No

  N/A

13.9 - Glove Bagging

• 13.9.1 - Is glove bag abatement being performed?

• 13.9.1(a) - Is the glove bag at least 6-mil thick?

  Yes

  No

  N/A

• 13.9.1(b) - If the glove bag is being used on elbows and other connections - has it been designed for that purpose?

  Yes

  No

  N/A

• 13.9.1(c) - Does the glove bag cover the entire circumference of the item being abated?

  Yes

  No

  N/A

• 13.9.1(d) - Do supervisor records show evidence that the glove bag has been smoke tested prior to use?

  Yes

  No

  N/A

• 13.9.1(e) - Has loose and friable asbestos materials adjacent to the glove bag operation been wrapped in at least two layers of 6-mil poly?

  Yes

  No

  N/A

• 13.9.1(f) - Does the glove bag set up allow the work to be performed, while maintaining integrity when water and waste are added?

  Yes

  No

  N/A

• 13.9.1(g) - Are at least two people perform the glove bag operation?

  Yes

  No

  N/A

13.10 - Waste Handling and Disposal

• 13.10.1 - Is debris being cleaned up and disposed of in a prompt manner?

  Yes

  No

  N/A

• 13.10.2 - Is debris being disposed of in leak tight containers?

  Yes

  No

  N/A

• 13.10.3 - Is debris properly labeled?

  Yes

  No

  N/A

• 13.10.4 - Have glove bags been collapsed using a HEPA vacuum prior to disposal?

  Yes

  No

  N/A

14.0 - DEMOLITION OPERATIONS

• 14.0 - Demolition Operations

• 14.1 - During demolition: when material is being dropped to the floor, is it being dropped in a manner which allows safe travel through the work area, and/or away from the work area by the person performing the task?

  Yes

  No

  N/A

• 14.2 - After demolition: have all residual hazards been removed? For example, overhead, laceration, or fall/trip hazards.

  Yes

  No

  N/A

• 14.3 - Is the work area being adequately protected from unauthorized access?

  Yes

  No

  N/A

• 14.4 - Have utilities been disconnected?

• 14.4.1 - How has this been confirmed?

• 14.5 - Are we performing working around live utilities?

• 14.5.1 - Describe our process for working around live utilities.

• 14.5.2 - Are these controls being followed?

  Yes

  No

  N/A

• 14.6 - Is concrete sawing and/or core drilling being performed?

• 14.6.1 - Has the slab or wall been scanned for utilities?

  Yes

  No

  N/A

• Describe why scanning of the slab or wall is not applicable.

• 14.7 - Does the work involve the use of a drop zone/chute?

• 14.7.1 - Is the drop zone/chute being protected by a red light/green light or similar system?

  Yes

  No

  N/A

• 14.7.2 - If over 20 feet in height, is the drop zone/chute protected by appropriate barriers?

  Yes

  No

  N/A

• 14.8 - Does the work involve structural demolition?

• 14.8.1 - Has an engineering survey been performed for the work?

  Yes

  No

  N/A

• 14.8.2 - Based on the engineering survey, has a demolition work plan been prepared for the work?

  Yes

  No

  N/A

• 14.8.3 - Is the work plan being followed?

  Yes

  No

  N/A

• 14.9 - Is silica being disturbed on this project?

• 14.9.1 - Have we performed (or are we performing) representative exposure monitoring?

  Yes

  No

  N/A

• 14.9.1(a) - Are the results available on site for employees to review?

  Yes

  No

  N/A

• 14.9.2 - Are dust control measures adequate?

  Yes

  No

  N/A

15.0 - LEAD (AND OTHER HEAVY METALS)

• 15.0 - Lead (and Other Heavy Metals)

• Is lead being disturbed?

• 15.1 - Has a site-specific lead compliance plan been prepared?

  Yes

  No

  N/A

• 15.1.1 - Does it adequately identify all the areas of lead we will disturb?

  Yes

  No

  N/A

• 15.1.2 - Has it been reviewed with the crew?

  Yes

  No

  N/A

• 15.1.3 - Does it identify adequate exposure prevention controls for the type lead work being performed?

  Yes

  No

  N/A

• 15.2 - Is the work area regulated using lead banner tape/signage? NOT REQUIRED IF EXPOSURE MONITORING SHOWS WE ARE BELOW THE ACTION LEVEL.

  Yes

  No

  N/A

• 15.3 - Are appropriate engineering controls being used to prevent exposure, i.e. ventilation, wet methods?

  Yes

  No

  N/A

• 15.4 - Are proper respirators being worn for type of work being performed?

  Yes

  No

  N/A

• 15.5 - Are respirator users medically cleared to wear respirators?

  Yes

  No

  N/A

• 15.6 - Are respirator users fit tested (within the last 12 months) for the respirator they are using?

  Yes

  No

  N/A

• 15.7 - Are disposable coveralls (and/or other PPE) being worn as required?

  Yes

  No

  N/A

• 15.8 - Has representative exposure monitoring been performed or has a negative exposure assessment been performed?

  Yes

  No

  N/A

• 15.9 - Are exposure results posted?

  Yes

  No

  N/A

• 15.10 - Have decontamination areas been set up?

  Yes

  No

  N/A

• 15.10.1 - Are they adequate for the work being performed?

  Yes

  No

  N/A

• 15.10.2 - Are they being used properly?

  Yes

  No

  N/A

• 15.11 - Has a TCLP been performed for the various waste streams?

  Yes

  No

  N/A

16.0 - OUTDOOR HEAT EXPOSURE

• 16.0 - Outdoor Heat Expoure

• 16.1 - Adequate supply of cool water/Gatorade available?

  Yes

  No

  N/A

• 16.2 - Adequate supply of cups (including disposal of used cups)?

  Yes

  No

  N/A

• 16.3 - Heat hazards discussed with crew?

  Yes

  No

  N/A

• 16.4 - Has the crew been trained in outdoor heat awareness?

  Yes

  No

  N/A

• 16.5 - Shaded area set up?

  Yes

  No

  N/A

17.0 - INDOOR AIR QUALITY

• 17.0 - Indoor Air Quality

• 17.1 - Is dust being adequately controlled within the building?

  Yes

  No

  N/A

• 17.2 - Is exhaust emitting equipment being operated inside the building?

• 17.2.1 - Are CO monitors on the equipment and/or designated spotter?

  Yes

  No

  N/A

• 17.2.2 - Have the CO monitors been calibrated within the last 30 days, or within manufacturers recommended timeframe?

  Yes

  No

  N/A

• 17.2.3 - Interview a representative sample of the employees on site - are they familiar with the steps to be taken in the event the CO alarm goes off?

  Yes

  No

  N/A

18.0 - LADDERS

• 18.0 - Ladders

• 18.1 - Podium ladder used properly?<br>

  Yes

  No

  N/A

• 18.2 - Extension ladder installed properly?

  Yes

  No

  N/A

• 18.3 - Extension ladders being used properly?

  Yes

  No

  N/A

• 18.4 - Ladders in good condition?

  Yes

  No

  N/A

19.0 - SCAFFOLDING

• 19.0 - Scaffolding

• Are we performing work on scaffolding?

• 19.1 - Was scaffolding erected by a competent person?

  Yes

  No

  N/A

• 19.2 - Has it been erected properly?

  Yes

  No

  N/A

• 19.3 - Was the scaffold inspected before use?

  Yes

  No

  N/A

• 19.4 - Is the type of scaffolding used adequate for the type of work being performed?

  Yes

  No

  N/A

• 19.5 - Is it adequately protected from collapse (secured to building, outriggers)?

  Yes

  No

  N/A

• 19.6 - Is the area providing access and egress free of debris, materials, and/or equipment?

  Yes

  No

  N/A

• 19.7 - Is the scaffolding being maintained in a safe and clean condition?

  Yes

  No

  N/A

• 19.8 - In icy conditions - are slip hazards being removed from the scaffold?

  Yes

  No

  N/A

20.0 - CONFINED SPACE

• 20.0 - Confined Space

• Are we performing work in confined spaces, as defined by industry standards?

• 20.1 - Is the confined space non-permit required?

• 20.1.1 - Was the reclassification of the confined space to non-permit properly documented?

  Yes

  No

  N/A

• 20.1.2 - Was the reclassification performed properly?

  Yes

  No

  N/A

• 20.2 - Is the confined space a permit-required confined space?

• 20.2.1 - Have employees been effectively informed about the existence, location, and hazards associated with the permit-required confined space?

  Yes

  No

  N/A

• 20.2.2 - Have measure been taken to prevent unauthorized access into the permit-required confined space?

  Yes

  No

  N/A

• 20.2.3 - Have the employees been properly trained?

  Yes

  No

  N/A

• 20.2.4 - Has a pre-entry permit been completed?

  Yes

  No

  N/A

• 20.2.4(a) - Does the permit clearly identify the space?

  Yes

  No

  N/A

• 20.2.4(b) - Does the permit clearly identify reason for entry?

  Yes

  No

  N/A

• 20.2.4(c) - Does the permit clearly identify date and authorized duration of the permit?

  Yes

  No

  N/A

• 20.2.4(d) - Does the permit clearly identify the hazards of the space being entered?

  Yes

  No

  N/A

• 20.2.4(e) - Does the permit clearly identify acceptable entry conditions?

  Yes

  No

  N/A

• 20.2.4(f) - Does the permit clearly identify the results of initial and periodic atmospheric tests?

  Yes

  No

  N/A

• 20.2.4(g) - Does the permit clearly identify measure taken to control the hazards associated with the space?

  Yes

  No

  N/A

• 20.2.4(h) - Does the permit clearly identify the entry supervisor?

  Yes

  No

  N/A

• 20.2.4(i) - Has the entry permit been approved and signed by the entry supervisor?

  Yes

  No

  N/A

• 20.2.4(j) - Does the permit clearly identify any equipment to be provided for safe entry?

  Yes

  No

  N/A

• 20.2.4(k) - Does the permit clearly identify means of rescue?

  Yes

  No

  N/A

• 20.2.5 - Are the entry permit requirements being followed?

  Yes

  No

  N/A

21.0 - HYGIENE AND SANITATION

• 21.0 - Hygiene and Sanitation

• 21.1 - Is the break/lunch room being maintained in a clean and hygienic condition?

  Yes

  No

  N/A

• 21.2 - Are there enough bathrooms for the number of people on site?

  Yes

  No

  N/A

• 21.3 - Are the onsite bathrooms being maintained in a clean and sanitary condition?

  Yes

  No

  N/A

22.0 - EXCAVATION AND TRENCHING

• 22.0 - Excavation and Trenching

• Are we performing work in or with trenches or excavations?

• 22.1 - Have surface hazards which could affect those inside the excavation been removed or protected?

  Yes

  No

  N/A

• 22.2 - Have calls been made to scan for utilities?

  Yes

  No

  N/A

• 22.2.1 - Have utilities been clearly identified (direction and depth)?

  Yes

  No

  N/A

• 22.2.2 - Will those markings remain visible throughout the excavation process?

  Yes

  No

  N/A

• 22.2.3 - Do those associated with the excavation understand the markings?

  Yes

  No

  N/A

• 22.3 - Has a safe means of access and egress been provided?

  Yes

  No

  N/A

• 22.3.1 - Is it being used as designed?

  Yes

  No

  N/A

• 22.4 - Are mobile equipment/vehicles in operation around the excavation?

• 22.4.1 - Are those associated with the excavation and those around the equipment/vehicles wearing Class II safety vests?

  Yes

  No

  N/A

• 22.4.2 - is there an approved warning system to control mobile equipment/vehicles operating adjacent to the excavation?

  Yes

  No

  N/A

• 22.5 - Are employees staying clear of overhead loads during the excavation process?

  Yes

  No

  N/A

• 22.6 - Is a water accumulation hazard present within or near the excavation?

• 22.6.1 - Have approved methods been implemented to prevent water accumulation undermining the stability of the excavation?

  Yes

  No

  N/A

• 22.6.2 - Is water pumps are being used to remove water, has a designated competent person been assigned to monitor?

  Yes

  No

  N/A

• 22.7 - Is the excavation adjacent to other structures?

• 22.7.1 - Has an appropriate means of supporting the adjacent structure been designed and installed?

  Yes

  No

  N/A

• 22.7.2 - Who designed the support system chosen?

• 22.8 - Can the supervisor provide you documented evidence that the excavation has been inspected prior to entering?

  Yes

  No

  N/A

• 22.9 - Are safe benching, sloping, bracing, or other approved methods being used to prevent collapse of the excavation?

  Yes

  No

  N/A

23.0 - TRAFFIC MANAGEMENT

• 23.0 - Traffic Management

• Are we performing work which involves public traffic management?

• 23.1 - Are flaggers currently certified?

  Yes

  No

  N/A

• 23.2 - Are flaggers using the correct traffic stop/slow sign?

  Yes

  No

  N/A

• 23.3 - Are advance warning signs in place?

  Yes

  No

  N/A

• 23.4 - Are flaggers wearing the appropriate PPE (hat, pants etc.)

  Yes

  No

  N/A

• 23.5 - Has a traffic management plan been developed?

  Yes

  No

  N/A

• 23.6 - Is the traffic management plan being followed?

  Yes

  No

  N/A

SIGN-OFF

• Project Supervisor

  Sign

• Auditor's signature

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