Overhead Audit

• Client / Site

• Document No.

• Audit Title

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Personal Protective Equipment

• Head Protection

  Yes

  No

  N/A

• Safety Glasses

  Yes

  No

  N/A

• Re-enforced safety toes boots

  Yes

  No

  N/A

• Rubber gloves, protectors and sleeves

  Yes

  No

  N/A

• Fall Protection

  Yes

  No

  N/A

• Reflective Vest (Class 2 or Class 3)

  Yes

  No

  N/A

• Flame Resistant Clothing (FR)

  Yes

  No

  N/A

• Hearing protection

  Yes

  No

  N/A

• Leather work gloves

  Yes

  No

  N/A

• seat belt in use on machine

  Yes

  No

  N/A

• Chaps in use

  Yes

  No

  N/A

• Clothes and PPE in good repair

  Yes

  No

  N/A

• Jewelry policy compliance

  Yes

  No

  N/A

Traffic Control

• Work site properly marked and /or barricaded

  Yes

  No

  N/A

• Flagmen are in place where needed

  Yes

  No

  N/A

• Flagman has received training

  Yes

  No

  N/A

• DOT signs and/or cones in place

  Yes

  No

  N/A

• Public Safety

  Yes

  No

  N/A

Job Preparation

• Tailboard completed accurately

  Yes

  No

  N/A

• Picture of tailboard

  Media

• Tailboard on job site

  Yes

  No

  N/A

• Tailboard understood and signed by crew

  Yes

  No

  N/A

• All hazard addressed

  Yes

  No

  N/A

• Effective control plan in place

  Yes

  No

  N/A

• Dedicated observer and hydration coach identified.

  Yes

  No

  N/A

• Who is observer and hydration plan?

  Yes

  No

  N/A

• locates for excavation zone active and updated.

  Yes

  No

  N/A

• non-reclousers/one shot/hotline tag when needed

  Yes

  No

  N/A

Vehicle and Equipment

• First Aid Kit

  Yes

  No

  N/A

• DVIR complete

  Yes

  No

  N/A

• Wheel chocks in use

  Yes

  No

  N/A

• Inspections/tags current

  Yes

  No

  N/A

• Dielectric and annual inspection in date

  Yes

  No

  N/A

• Fire Extinguisher Monthly inspection

  Yes

  No

  N/A

• Vehicles grounded properly

  Yes

  No

  N/A

• Housekeeping on trucks and equipment

  Yes

  No

  N/A

• Extra bulbs/extra fuses on DOT trucks

  Yes

  No

  N/A

• Equipment set-up (barricaded, mat and rubber gloves out)

  Yes

  No

  N/A

• outrigger pads in use

  Yes

  No

  N/A

• IFTA filled out

  Yes

  No

  N/A

• Proper license to operate vehicle

  Yes

  No

  N/A

Work Methods and Practices

• Switch order/clearances

  Yes

  No

  N/A

• Line of Fire/pinch points

  Yes

  No

  N/A

• Proper cover up (line hoses, blankets, pole guards)(I&I)(CESR)

  Yes

  No

  N/A

• I&I and CESR standards understood by crew?

  Yes

  No

  N/A

• Overall Housekeeping of job site

  Yes

  No

  N/A

• Pole lights on poles in transport

  Yes

  No

  N/A

• Proper lifting techniques

  Yes

  No

  N/A

• Spotter used if backing

  Yes

  No

  N/A

• Drinking water

  Yes

  No

  N/A

• Two people with CPR/First Aid

  Yes

  No

  N/A

• Lead Man on job site

  Yes

  No

  N/A

• Safety handbook on site

  Yes

  No

  N/A

• Cell phone usage

  Yes

  No

  N/A

• Tool proper use and in good condition

  Yes

  No

  N/A

• Required training to complete work assigned

  Yes

  No

  N/A

• Proper classification for work assigned

  Yes

  No

  N/A

• Rigging and rigging equipment

  Yes

  No

  N/A

Leadership and Behaviors

• Safe completion of job a priority to crew

  Yes

  No

  N/A

• Exhibits proactive safety behaviors

  Yes

  No

  N/A

• Was crew or individual receptive to feedback

  Yes

  No

  N/A

• Was HPI tools being used and represented by crew members?

  Yes

  No

  N/A

• Self Check -STAR

  Yes

  No

  N/A

• Peer Check

  Yes

  No

  N/A

• Second Check

  Yes

  No

  N/A

• Questioning Attitude

  Yes

  No

  N/A

• Procedure Usage and Adherence

  Yes

  No

  N/A

• Critical Step Check

  Yes

  No

  N/A

• Post Job Review

  Yes

  No

  N/A

• Effective Communication

  Yes

  No

  N/A

• Signature of Foreman

  Sign

• Signature of Inspector

  Sign