Pieper Electric, Inc. - Safety Audit 2017.1

• Audit No.

• Branch #

  Select br. 1 Wastewater - Grinka br. 4 Major construction - Scritsmier br. 6 Madison/Janesville - Borgardt br. 7 Industrial - Trummer br. 8 Ideal - Becker br. 9 Pieper/Systems Technologies - Kelliher br. 11 Automation - West br. 12 HiTech - Thode br. 14 Kenosha/Illinois - Wierzba br. 17 Industrial/Service/Jobbing - Roberts br. 18 Light Construction - Phelps br. 26 Industrial/Service/Jobbing - Woloszyk br. 41 Fox Valley - Burich Other

  • br. 1 Wastewater - Grinka
  • br. 4 Major construction - Scritsmier
  • br. 6 Madison/Janesville - Borgardt
  • br. 7 Industrial - Trummer
  • br. 8 Ideal - Becker
  • br. 9 Pieper/Systems Technologies - Kelliher
  • br. 11 Automation - West
  • br. 12 HiTech - Thode
  • br. 14 Kenosha/Illinois - Wierzba
  • br. 17 Industrial/Service/Jobbing - Roberts
  • br. 18 Light Construction - Phelps
  • br. 26 Industrial/Service/Jobbing - Woloszyk
  • br. 41 Fox Valley - Burich
  • Other

• Jobsite

• Location
  Address

• Conducted on

  Date

• Project Manager(s)

• Personnel

• Foreman/Field Lead

• Conducted By:

PPE

• Hard Hat

  Yes

  No

  N/A

• Safety Glasses

  Yes

  No

  N/A

• Gloves

  Yes

  No

  N/A

• Other Applicable PPE

  Yes

  No

  N/A

Paperwork

• Job Hazard Analysis

  Completed

  Not Completed

• JHA Grade

• Project Safety Plan Completed

  Yes

  No

  N/A

Tool/Electrical Safety

• Cord/Tool Inspection

  Safe

  At Risk

  N/A

• GFCI Protection

  Safe

  At Risk

  N/A

• Temporary Lighting

  Safe

  At Risk

  N/A

• Temporary Power

  Safe

  At Risk

  N/A

• Electrical Safe Work Practices

  Safe

  At Risk

  N/A

• Lock Out/Tag Out

  Yes

  No

  N/A

Other Potential Safety Issues

• Ladder Safety

  Safe

  At Risk

  N/A

• Aerial Lift Safety

  Safe

  At Risk

  N/A

• Housekeeping

  Safe

  At Risk

  N/A

• Fall Protection

  Safe

  At Risk

  N/A

• Material Handling

  Safe

  At Risk

  N/A

• Trenching/Excavation

  Safe

  At Risk

  N/A

• Pre-planning For Safety

  Yes

  No

  N/A

• Other Issues

  No

  Yes

• How Many?

  1

  2

  3

  4

  5

Vehicle Safety

• Company Vehicle/Service Van 1

  Safe

  At Risk

  N/A

• Company Vehicle/Service Van 2

  Safe

  At Risk

  N/A

• Company Vehicle/Service Van 3

  Safe

  At Risk

  N/A

• Reoccurring Issues

  No

  Yes

• General Contractor/Customer Safety Issues

  No

  Yes

• Other Compliance/Safety/Behavioral Concerns

• Other Compliance/Safety/Behavioral Concerns Pictures

  Media

• Corrective Actions Taken While on Site

• Positive Takeaways/Comments

• I have reviewed this safety audit and will address the items noted.

  Sign