Title Page
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
BEHAVIOR
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JSA signed and reviewed?
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JSA written thoroughly and covers each task?
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Mentors/Supervisors identified?
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Hazard Recognition/Near miss Reporting?
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Other
WORK AREAS
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General Housekeeping
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Walking-Working Surfaces
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Unprotected sides and holes
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Impalement Hazards
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Sanitary Facilities
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Water/Trash Receptacles
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Material Storage/Laydown/Tool Trailer
JOB SITE INFORMATION
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OSHA Required Posters
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Emergency Evacuations
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Emergency Contacts List
HEALTH/FIRST AID
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CPR/First Aid Trained?
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First Aid Kit (complete, no expired items)
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Eye Wash Station in Field/ Accessible?
PERSONAL PROTECIVE EQUIPMENT
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Hard Hats
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Safety Glasses w/ side sheilds
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Face Shield/ Goggles (if required)
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Respiratory Protection (if required)
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Hearing Protection (if required)
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FRC (if required)
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Hand/Foot Protection
FALL PROTECTION
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Competent Person (trained)
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Inspected/ Color Coded
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Worn Properly
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Tied Off/ Suitable Anchorage Point
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Stored Properly
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Rescue Plan in Place?
SCAFFOLDING/LADDERS
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Competent Person (trained)
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Hand/Mid Rails, Toe Boards
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Full Platform
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Level Base/ Footing
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Inspected/Tagged (scaffold)
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Inspected/ Color Coded (ladders)
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Access/Egress
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Away from Powerlines
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Barricades
TOOLS AND EQUIPMENT
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In Good Condiion
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Inspected/ Color Coded
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Pins/ Whip-Checks
EXCAVATIONS
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Competent Person (trained)
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Access/ Egress
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Soil Condition
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Water Accumulation
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Shoring/Shielding/Sloping
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Spoil Pile
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Air Monitoring
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Emergency/ Rescue Plan
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Barricades (when no work taking place)
CONFINED SPACE
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COMPETENT/ TRAINED PERSONNEL
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Attendant Trained
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Confined Space Log
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Permit Required/ Followed
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Air Monitoring
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Emergency/Rescue Plan
ELECTRICAL TOOLS
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G.F.C.I.'s
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Extension Cords
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Power Tools
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LOTO
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Assured Ground Inspections
FIRE SAFETY
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Hot Work Permit (if required)
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Fire Watch Assigned (trained)
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Fire Extinguisher Inspected/Current
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Combustible Material Removed/Isolated
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Gas Cans
RIGGING AND HOISTING
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Capacity Tags
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Hooks and Latches
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Chain falls/ Come-a-longs
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Tag Lines
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Inspected/Color Coded
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Qualified Rigger
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Damage
CRANE EQUIPMENT/ SET UP
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Crane Inspection
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Crane Set up
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Swing Radius
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Flagger/Spotter w/vest
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Qualified Operator/ Rigger
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Fall Zone
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Lift Plan
HEAVY EQUIPMENT
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Equipment Inspections
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Qualified and Certified Operator
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Spotter w/vest
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Proper Set up and Use
HAZCOM
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Training
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SDS on site
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SDS for all Chemicals
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Proper Storage
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Proper PPE for Handling Chemicals
OTHER
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COMMENTS/ RECOMMENDATIONS
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SIGN OFF
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SAFETY REP
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SITE SUPERINTENDANT
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GENERAL FOREMAN
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CONSTUCTION SUPERVISOR
