Title Page

  • Patriot Job Number

  • Reason For Visit

  • Date & Time

  • Inspector

  • Site Foreman

  • Location(s) Inspected
  • INSTRUCTIONS:
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    1. Answer the applicable questions below.
    2. Add photos and notes by clicking on the paperclip icon.
    3. To add a Corrective Measure click on the paperclip icon then "Add Action", provide a description, assign to a member, set priority and due date.
    4. Complete audit by providing digital signature.
    5. Share your report by exporting as PDF, Word, Excel or Web Link.

A. General

  • 1. Are the public and other trades adequately protected from any dangers posed by our work?

  • 2. Are the general work areas neat and orderly?

  • 3. Is trash being placed in proper receptacles?

  • 4. Does the foreman know the location of the closest hospital?

  • 5. Have all employees taken part in a JHA discussion for their particular work task within the last week?

  • 6. Do all employees have access to potable water?

  • 7. Is a first aid kit available?

  • 8. Are SDS readily available to all employees on site?

  • 9. Are all flammable liquids stored in approved safety cans?

  • 10. Are all flammable liquid storage containers labeled appropriately?

  • 11. Is a fire extinguisher readily available, inspected monthly, and maintained annually?

  • 12. Are all employees protected from accidental injury or impalement by sharp or slender objects (protruding nails, rebar, etc.)?

B. Slip, Trip, and Fall Prevention

  • 1. Are all unattended manhole, catch basin, and similar openings protected with barricades or fencing, or covered securely with plywood or similar?

  • 2. Are all hoses, cords, cables, nylon strapping, metal banding, shovels, rakes, etc., placed neatly outside of common employee travelways?

  • 3. If hose, cable, cord, etc., must cross a common employee travelway is it securely fastened in such a manner as to prevent tripping?

  • 4. Are all excavations where crews are not actively working protected either by barricades, fencing, or parked machine?

  • 5. Are employees working on retaining walls higher than 6’ protected by guardrails or a personal fall arrest system?

C. Ladder Safety

  • 1. If an employee is using a ladder have then been trained in ladder safety?

  • 2. Does the ladder extend at least 3’ above the upper landing?

  • 3. Is the ladder positioned such that the ‘run’ of the ladder is about 1/4 of the ‘rise’?

  • 4. Is the ladder in good working condition?

  • 5. Is the ladder securely fastened, either by embedment into earth or some type of rope or cable?

  • 6. Stepladders are being used only in the open position?

  • 7. Are all ladder rungs free from grease and oil?

  • 8. Are employees facing the ladder and maintaining three points of contact?

D. Personal Protective Equipment (PPE)

  • 1. Are hard hats being worn by all employees?

  • 2. Are work boots being worn by all employees?

  • 3. Are jeans, canvas, or similar long pants being worn by all employees?

  • 4. Are gloves, traffic vests, earplugs, safety glasses, and similar PPE readily available to all employees?

  • 5. Is hearing protection being worn where required?

  • 6. Are gloves being worn where required?

  • 7. Are traffic vests being worn where required?

  • 8. Are safety glasses being worn where required?

  • 9. Is all utilized and available PPE in good working condition?

E. Trenching and Excavation

  • 1. Has the competent person inspected the excavation prior to any employee entering?

  • 2. Has a Excavation Permit been filled out?

  • 3. Is the crew aware of all potential existing utilities in the work area?

  • 4. Is the crew aware of all overhead electrical lines in the work area?

  • 5. Has the competent person inspected the trench prior to an employee entering?

  • 6. Are all excavations 5’ or greater in depth protected from cave-in by proper shoring or sloping?

  • 7. Are the sides of all trenches sloped at a rate no greater than 1.5H:1V?

  • 8. Trench Box Safety

  • a. Is the tabulated data sheet on site for this trench box?

  • b. Is the excavation no greater than 2’ below the bottom of the trench box?

  • c. Does the trench box extend at least 18” above the top of the vertical sides of the trench?

  • 9. Are spoils kept at least 2 feet away from the trench edge?

  • 10. Is a ladder present in all excavations 4’ or greater in depth?

  • 11. If a ladder is used is it positioned such that no employee has to travel greater than 25’ to access it?

  • 12. Is the trench protected from water accumulation?

F. Hand & Power Tools

  • 1. Are shafts and handles of all tools free from cracks and in good working condition?

  • 2. Are all tools stored neatly and protected from damage?

  • 3. Are the proper tools being used for the job?

  • 4. Are all power cords and extension cords free from cuts, frays, or other damage?

  • 5. Have the employees operating a power tool been trained on that specific tool?

  • 6. Are all impact tools free from splinters or mushrooms?

  • 7. Are all damaged or malfunctioning tools tagged out?

  • 8. Are all guards on tools in place and working properly?

  • 9. Are GFCI’s used for all portable electric tools?

G. Heavy Equipment/ Trucks

  • 1. Are all backup alarms functioning properly?

  • 2. Do all machines have inspected fire extinguishers.

  • 3. Are all seat belts functioning and being used?

  • 4. Are inspection sheets or pre-trip post trip sheets available and correctly filled out?

H. Material Handling and Rigging

  • 1. Are employees using proper lifting techniques when lifting objects manually?

  • 2. Are machines being used to lift heavy objects?

  • 3. Do all chains and straps have a legible capacity rating tag?

  • 4. Are all chains and straps being used according to their capacity rating?

  • 5. Do hooks used for lifting have a safety latch in place?

  • 6. Are tag lines available and being used when appropriate?

  • 7. Employees are not allowed underneath any overhead load?

  • 8. Are lifting chains being rigged properly?

  • 9. Are loads that have the potential to swing during movement being secured?

  • 10. Are all lifting apparatus stored neatly and protected from weather and other damage?

Completion

  • Inspected by

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