Port Morris Tile & Marble Corp. L.P.

• Document No.

• Contract No.

• Customer/Owner

• Conducted on

  Date

• Prepared by

• Location
  Address

General and Administrative Safety

• HASP ONSITE?

  Yes

  No

  N/A

• COMPETENT PERSON ONSITE?

  Yes

  No

  N/A

• TAKE 5/TOOLBOX/JHA USED?

  Yes

  No

  N/A

• OSHA CERTS/SCAFFOLD CERTS IN PLACE?

  Yes

  No

  N/A

• FIRST AID KITS PRESENT?

  Yes

  No

  N/A

• COMMENTS ON GENERAL AND ADMINISTRATIVE

Personal Protective Equipment

• HARD HATS?

  Yes

  No

  N/A

• HIGH VIS VEST/SHIRTS?

  Yes

  No

  N/A

• EYE PROTECTION?

  Yes

  No

  N/A

• APPROPRIATE FOOTWEAR/FOOT PROTECTION?

  Yes

  No

  N/A

• HEARING PROTECTION?

  Yes

  No

  N/A

• HAND PROTECTION?

  Yes

  No

  N/A

• RESPIRATORY PROTECTION?

  Yes

  No

  N/A

• PROPER CLOTHING?

  Yes

  No

  N/A

• COMMENTS ON PERSONAL PROTECTIVE EQUIPMENT

Work Area Protection

• HOUSEKEEPING?

  Yes

  No

  N/A

• WALKWAY/EGRESS CLEAR AND CLEAN?

  Yes

  No

  N/A

• CONTROLLED ACCESS ZONES IN PLACE?

  Yes

  No

  N/A

• PROPER LIGHTING?

  Yes

  No

  N/A

• FIRE EXTINGUISHER IN PLACE?

  Yes

  No

  N/A

• FALL PROTECTION AS NEEDED?

  Yes

  No

  N/A

• FLAG PERSON AS NEEDED?

  Yes

  No

  N/A

• COMMENTS ON W.A.P.

Material, Tools and Equipment

• MATERIALS AND EQUIPMENT STORED PROPERLY?

  Yes

  No

  N/A

• ALL EQUIPMENT INSPECTED PRIOR TO USE?

  Yes

  No

  N/A

• SCAFFOLDS INSPECTED PRIOR TO USE?

  Yes

  No

  N/A

• LADDERS INSPECTED PRIOR TO USE?

  Yes

  No

  N/A

• RIGGING AND SLINGS INSPECTED PRIOR TO USE?

  Yes

  No

  N/A

• MANLIFT/SCISSOR LIFT TRAINING COMPLETED?

  Yes

  No

  N/A

• COMMENTS ON MATERIAL, TOOLS AND EQUIPMENT

Summary

• ADDITIONAL AUDIT COMMENTS