Title Page
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Patriot Job Number
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Reason For Visit
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Date & Time
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Inspector
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Site Foreman
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Location(s) Inspected
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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
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1. Are the public and other trades adequately protected from any dangers posed by our work?
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2. Are the general work areas neat and orderly?
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3. Is trash being placed in proper receptacles?
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4. Does the foreman know the location of the closest hospital?
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5. Have all employees taken part in a JHA discussion for their particular work task within the last week?
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6. Do all employees have access to potable water?
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7. Is a first aid kit available?
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8. Are SDS readily available to all employees on site?
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9. Are all flammable liquids stored in approved safety cans?
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10. Are all flammable liquid storage containers labeled appropriately?
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11. Is a fire extinguisher readily available, inspected monthly, and maintained annually?
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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
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1. Are all unattended manhole, catch basin, and similar openings protected with barricades or fencing, or covered securely with plywood or similar?
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2. Are all hoses, cords, cables, nylon strapping, metal banding, shovels, rakes, etc., placed neatly outside of common employee travelways?
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3. If hose, cable, cord, etc., must cross a common employee travelway is it securely fastened in such a manner as to prevent tripping?
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4. Are all excavations where crews are not actively working protected either by barricades, fencing, or parked machine?
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5. Are employees working on retaining walls higher than 6’ protected by guardrails or a personal fall arrest system?
C. Ladder Safety
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1. If an employee is using a ladder have then been trained in ladder safety?
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2. Does the ladder extend at least 3’ above the upper landing?
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3. Is the ladder positioned such that the ‘run’ of the ladder is about 1/4 of the ‘rise’?
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4. Is the ladder in good working condition?
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5. Is the ladder securely fastened, either by embedment into earth or some type of rope or cable?
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6. Stepladders are being used only in the open position?
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7. Are all ladder rungs free from grease and oil?
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8. Are employees facing the ladder and maintaining three points of contact?
D. Personal Protective Equipment (PPE)
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1. Are hard hats being worn by all employees?
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2. Are work boots being worn by all employees?
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3. Are jeans, canvas, or similar long pants being worn by all employees?
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4. Are gloves, traffic vests, earplugs, safety glasses, and similar PPE readily available to all employees?
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5. Is hearing protection being worn where required?
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6. Are gloves being worn where required?
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7. Are traffic vests being worn where required?
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8. Are safety glasses being worn where required?
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9. Is all utilized and available PPE in good working condition?
E. Trenching and Excavation
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1. Has the competent person inspected the excavation prior to any employee entering?
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2. Has a Excavation Permit been filled out?
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3. Is the crew aware of all potential existing utilities in the work area?
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4. Is the crew aware of all overhead electrical lines in the work area?
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5. Has the competent person inspected the trench prior to an employee entering?
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6. Are all excavations 5’ or greater in depth protected from cave-in by proper shoring or sloping?
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7. Are the sides of all trenches sloped at a rate no greater than 1.5H:1V?
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8. Trench Box Safety
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a. Is the tabulated data sheet on site for this trench box?
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b. Is the excavation no greater than 2’ below the bottom of the trench box?
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c. Does the trench box extend at least 18” above the top of the vertical sides of the trench?
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9. Are spoils kept at least 2 feet away from the trench edge?
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10. Is a ladder present in all excavations 4’ or greater in depth?
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11. If a ladder is used is it positioned such that no employee has to travel greater than 25’ to access it?
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12. Is the trench protected from water accumulation?
F. Hand & Power Tools
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1. Are shafts and handles of all tools free from cracks and in good working condition?
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2. Are all tools stored neatly and protected from damage?
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3. Are the proper tools being used for the job?
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4. Are all power cords and extension cords free from cuts, frays, or other damage?
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5. Have the employees operating a power tool been trained on that specific tool?
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6. Are all impact tools free from splinters or mushrooms?
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7. Are all damaged or malfunctioning tools tagged out?
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8. Are all guards on tools in place and working properly?
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9. Are GFCI’s used for all portable electric tools?
G. Heavy Equipment/ Trucks
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1. Are all backup alarms functioning properly?
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2. Do all machines have inspected fire extinguishers.
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3. Are all seat belts functioning and being used?
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4. Are inspection sheets or pre-trip post trip sheets available and correctly filled out?
H. Material Handling and Rigging
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1. Are employees using proper lifting techniques when lifting objects manually?
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2. Are machines being used to lift heavy objects?
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3. Do all chains and straps have a legible capacity rating tag?
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4. Are all chains and straps being used according to their capacity rating?
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5. Do hooks used for lifting have a safety latch in place?
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6. Are tag lines available and being used when appropriate?
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7. Employees are not allowed underneath any overhead load?
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8. Are lifting chains being rigged properly?
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9. Are loads that have the potential to swing during movement being secured?
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10. Are all lifting apparatus stored neatly and protected from weather and other damage?
Completion
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Inspected by