Title Page

  • Site conducted

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Traffic Control

  • Are traffic cones in use and placed properly?

  • Are the proper signs in use and placed properly?

  • Is the manhole guard set up and properly placed at the up stream manhole?

  • Is the manhole guard set up and properly placed at the down stream manhole?

  • Are flaggers or a Detail present on the job site if required?

Confined Space Equipment

  • Has the workers air meter gone in for calibration (once every 30 days)?

  • Is the tripod and winch properly set up at the up stream manhole?

  • Is the tripod and winch properly set up at the down stream manhole?

  • Is the gas detector set up and properly working at the up stream manhole?

  • Is the gas detector set up and properly working at the down stream manhole?

  • Is the blower set up and working properly?

  • Are lifelines properly set up and in use if required?

  • Are the harnesses in proper condition?

  • Is the Confined Space Permit filled out completely and visible?

PPE

  • Are all crew members using proper steel toe boats?

  • Are hard hats in use?

  • Are safety vest in use?

  • Is the crew using ear protection and is the the proper type for the job?

  • Is the crew using the proper Tyvek chemical suit (Yellow or White) for the job?

  • Is the crew using the proper eye protection(Safety glasses of Safety goggles)?

  • Is the crew using face shield if required?

  • Is the proper hand protection being used?

  • Is the proper respiratory protection being used?

Vehicle Equipment

  • IS the DVIR fill out and accurate?

  • Is the log book filled out and up to date?

  • Does the vehicle have a proper First Aid kit?

  • Does the vehicle have the proper Fire Extinguishers?

  • Does the vehicle have Triangles?

  • Does the vehicle have Chock Blocks?

  • Does the vehicle have a MSDS book?

  • Is the crew following standard operating procedure for the vehicle?

  • Is the eye wash station stocked?

  • Are radios in proper working condition?

  • Is the By-Pass working properly?

  • Is the By-Pass hose in proper working condition?

Materials

  • Is the proper resin being used?

  • Are chemical buckets properly labeled?

Housekeeping

  • Is the truck clean?

  • Is the equipment maintained?

  • Are all tools in good working condition?

  • Are crew members wearing the proper uniforms and look presentable?

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.