Title Page
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Who is conducting the audit?
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Project Number/Name
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Conducted on
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Are all employees signed onto the Pre Task Plan?
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Is the Task for the Day stated?
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Sequence of Job Steps:
- 1 - Job step very vague, unable to know job from Pre Task Plan
- 2 - Able to understand job task but steps are vague
- 3 - Job steps are in order but details of job could have more detail
- 4 - Job steps are written in a way that the Pre Task Plan could be used as a step by step guide to perform the job.
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Hazard Identification:
- 1 - Generic items that DON'T relate to the job task: Slips/Trips/Falls, Weather, Pinch Points
- 2 - Generic items that DO relate to job task: Slips/Trips/Falls, Pinch Points, Etc.
- 3 - Distinct hazard ID related to job task along with some generic items
- 4 - Excellent hazard ID related to job task
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Have materials, supplies, tools or safety equipment needed for today's task been listed?
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PPE Required for Task:
- 0 - Not filled out/left blank
- 1 - Some PPE is selected but missing items required for the job task
- 2 - Proper PPE is selected for the job tasks
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Documented Control Measures:
- 0 - No control measures listed
- 1 - Generic items only for controls: watch footing, wear PPE, watch hand placement
- 2 - Distinct controls documented with some generic items included
- 3 - Clear "instructional" controls documented
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Are Inspections Performed assigned to crew members?
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Has the Pre Task Plan been closed out properly if this audit is not in the field? (Issues listed if any, injury boxes marked, and foreman signature)
Photo of JSA
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Front of Pre Task Plan
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Back of Pre Task Plan
