On-site Safety Visit

• Employee(s) On-site

  Select Joe Wilson Danny Carpenter Jackie Cary Cory Lauber Jimmy Bostwick David Knee Adam Worrell Todd Sorrells Bruce Saunders Barry Caldwell Robert Laxton Daniel Imler Brent Levy Cody Adams Justin Price Joel Rodriguez Matt Potter Antar Khaalis Anthony Deleza Trey Henderson Michael Ashdown Robbie Pierce Patrick Wells

  • Joe Wilson
  • Danny Carpenter
  • Jackie Cary
  • Cory Lauber
  • Jimmy Bostwick
  • David Knee
  • Adam Worrell
  • Todd Sorrells
  • Bruce Saunders
  • Barry Caldwell
  • Robert Laxton
  • Daniel Imler
  • Brent Levy
  • Cody Adams
  • Justin Price
  • Joel Rodriguez
  • Matt Potter
  • Antar Khaalis
  • Anthony Deleza
  • Trey Henderson
  • Michael Ashdown
  • Robbie Pierce
  • Patrick Wells

• Conducted on

  Date

• Foreman/Crew Leader In Charge

  Select Joe Wilson Danny Carpenter Jackie Cary Cory Lauber Jimmy Bostwick David Knee Adam Worrell Todd Sorrells Bruce Saunders Barry Caldwell Robert Laxton Daniel Imler Brent Levy Cody Adams Justin Price Joel Rodriguez Matt Potter Antar Khaalis Anthony Deleza Trey Henderson Michael Ashdown Robbie Pierce Patrick Wells

  • Joe Wilson
  • Danny Carpenter
  • Jackie Cary
  • Cory Lauber
  • Jimmy Bostwick
  • David Knee
  • Adam Worrell
  • Todd Sorrells
  • Bruce Saunders
  • Barry Caldwell
  • Robert Laxton
  • Daniel Imler
  • Brent Levy
  • Cody Adams
  • Justin Price
  • Joel Rodriguez
  • Matt Potter
  • Antar Khaalis
  • Anthony Deleza
  • Trey Henderson
  • Michael Ashdown
  • Robbie Pierce
  • Patrick Wells

• Prepared by

• Location
  Address

1. Personal Protective Equipment

• Hard hats,safety glasses, being worn in accordance with company safety policy.

  Safe

  At Risk

  N/A

• Proper clothing is being worn.

  Safe

  At Risk

  N/A

• Necessary fall protection is being utilized.

  Safe

  At Risk

  N/A

• Ear protection, gloves,etc. being worn.

  Safe

  At Risk

  N/A

• Respiratory protection worn.

  Safe

  At Risk

  N/A

2. Hand and Power Tools

• All required guards are in place and being used properly.

  Safe

  At Risk

  N/A

• Powder actuated tools are being used properly and stored correctly also.

  Safe

  At Risk

  N/A

• Necessary training and safety documentation is on site with General Superintendent.

  Yes

  No

  N/A

4. Equipment Checklist

• Unsafe or damaged equipment?

  Safe

  At Risk

  N/A

• Loads lifted over persons, close proximity to obstacles incl. overhead power lines?

  Safe

  At Risk

  N/A

• Lack of daily inspection protocol?

  Safe

  At Risk

  N/A

• Unsafe or damaged lifting equipment, including ropes, slings, chains, hooks?

  Safe

  At Risk

  N/A

• Unlicensed operators?

  Safe

  At Risk

  N/A

• Safe lifting load or lifting equipment exceeded?

  Safe

  At Risk

  N/A

• Necessary training and safety documentation is on site with General Superintendent.

  Yes

  No

  N/A

5. Excavation and Trenching

• Necessary barricades in place and visible.

  Safe

  At Risk

  N/A

• Necessary shoring is in place and extends at least 18 inches above trench or excavation.

  Safe

  At Risk

  N/A

• Necessary ladders are in place and at the correct locations.

  Safe

  At Risk

  N/A

• Spoil piles are at least 2 feet away from edge of trench or excavation.

  Safe

  At Risk

  N/A

• Required Competent person is on site at all times while work is being conducted

  Safe

  At Risk

  N/A

10. Traffic Control

• Lack of, or inadequate, Traffic Management Plan (TMP) in place?

  Safe

  At Risk

  N/A

• Lack of training in TMP for all persons on site? <br>(contractors and visitors)

  Safe

  At Risk

  N/A

• Inadequate controls for TMP? (physical barriers, bollards, speed limits, flashing lights, spotters, etc)

  Safe

  At Risk

  N/A

13. Fall Protection

• Necessary fall protection in place as required and used correctly.

  Safe

  At Risk

  N/A

Corrective Actions

• Enter any corrective actions that will be undertaken

Sign Off

• On site representative

  Sign

• Auditor's signature

  Sign