Project EH&S Survey (March 2013)

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Personal Protective Equipment (PPE)

• Hard Hats

  Safe

  At Risk

  N/A

• Hearing Protection

  Safe

  At Risk

  N/A

• Respiratory Protection

  Safe

  At Risk

  N/A

• Proper Work Attire

  Safe

  At Risk

  N/A

• Proper Footwear

  Safe

  At Risk

  N/A

• Hand Protection

  Safe

  At Risk

  N/A

• Eye / Face Protection

  Safe

  At Risk

  N/A

Housekeeping

• Access & Egress Clear (Stairs, Isles, Walkways)

  Safe

  At Risk

  N/A

• Material Properly Stacked / Stored

  Safe

  At Risk

  N/A

• Debris / Trash Removal

  Safe

  At Risk

  N/A

• Nails - Bent / Removed

  Safe

  At Risk

  N/A

Ladders / Stairs

• Stair Railings / Hand Rails / Pan Fillers

  Safe

  At Risk

  N/A

• Ladder Condition / Type

  Safe

  At Risk

  N/A

• Secured / Tied Off

  Safe

  At Risk

  N/A

• Extends 3' Above Landing

  Safe

  At Risk

  N/A

• Proper Use / Corral at Top

  Safe

  At Risk

  N/A

Fall Protection

• Guardrail / Mid-Rail / Toe board / Perimeter cable

  Safe

  At Risk

  N/A

• Floor Hole Covers / Secure / Labelled

  Safe

  At Risk

  N/A

• Personal Fall Arrest / Fall Restraint / Proper design / Swing Fall

  Safe

  At Risk

  N/A

• Elevator Shaft Protection / Debris Removed

  Safe

  At Risk

  N/A

• Slips / Trips / Falls

  Safe

  At Risk

  N/A

Scaffolding / False Work / Shoring / Decking / Concrete

• Planks / Decks / Platforms Installed Properly

  Safe

  At Risk

  N/A

• Impalement Protection / Rebar Caps / Troughs

  Safe

  At Risk

  N/A

• Proper Access / Ladder / Inspection

  Safe

  At Risk

  N/A

• Proper Bracing / Re-Shore / Pads

  Safe

  At Risk

  N/A

• Inspected / Secured / Structurally Sound

  Safe

  At Risk

  N/A

Electrical

• Adequate Lighting - Task / Area

  Safe

  At Risk

  N/A

• Grounding / Inspection / GFCI Use

  Safe

  At Risk

  N/A

• Cords Elevated / Receptacles / Plugs / Inspected

  Safe

  At Risk

  N/A

• Lockout / Tagout (LOTO) / Energy Controlled / Rooms Secured / Arc Flash

  Safe

  At Risk

  N/A

Fire Protection / Prevention

• Adequate Extinguishers (Area & Task) / Inspected / Nearby

  Safe

  At Risk

  N/A

• Flammable Materials Storage

  Safe

  At Risk

  N/A

• Proper Welding / Cutting Equipment / Flashback Arrestors

  Safe

  At Risk

  N/A

• Hot Work Permit / Firewatch

  Safe

  At Risk

  N/A

Tools - Hand & Power

• Good Condition / Inspected

  Safe

  At Risk

  N/A

• Guarded / Guards in Place

  Safe

  At Risk

  N/A

• Use Properly / No Modifications

  Safe

  At Risk

  N/A

Site / Public Protection

• Barricading / Fences / Pedestrian Canopy

  Safe

  At Risk

  N/A

• Adequate Signage / Lighting

  Safe

  At Risk

  N/A

• Traffic Control Plan / Flagging

  Safe

  At Risk

  N/A

Emergency Preparedness / First Aid

• Trained Personnel

  Safe

  At Risk

  N/A

• First Aid Kits / Supplies

  Safe

  At Risk

  N/A

• Adequate Sanitation / Hand washing / Water

  Safe

  At Risk

  N/A

Programs / Information / Right to Know

• Periodic Management Inspctions

  Safe

  At Risk

  N/A

• Hazards Properly Identified / Job Hazard Analysis (JHA/AHA)

  Yes

  No

  N/A

• Safety Passport / Orientation / Haz-Com / MSDS / Right to Know

  Safe

  At Risk

  N/A

• Safety / Tool-box Meetings

  Safe

  At Risk

  N/A

• Posting Requirements / Signs

  Safe

  At Risk

  N/A

• Heat Illness Plan / Training / Adequate Water / Shade

  Safe

  At Risk

  N/A

Equipment / Crane / Lifts / Hoisting & Rigging

• Equipment Certifications / Inspections / Alarms / Properly Parked

  Safe

  At Risk

  N/A

• Operator Certification / Qualifications / Seatbelts

  Safe

  At Risk

  N/A

• Lift Plan / Load Swing Planned / Radius Protection / Power lines Identified

  Safe

  At Risk

  N/A

• Rigger / Signal Person Qualifications / Spotter

  Safe

  At Risk

  N/A

• Ground / Area Survey / Stability / No Open Holes / Depressions

  Safe

  At Risk

  N/A

Underground / Overhead / Confined Space

• Active USA / Underground Utilities Marked / Protected Pot-holing

  Safe

  At Risk

  N/A

• Confined Spaces - Identified / Training / Permits

  Safe

  At Risk

  N/A

• Excavations / Trenches - Shoring / Benching / Sloping / Access / PE > 20'

  Safe

  At Risk

  N/A

• Equipment / Material At least 10' from Powelines

  Safe

  At Risk

  N/A

Other / Misc.

• Other / Misc.

  Safe

  At Risk

  N/A