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
Project Information:
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Project:
- ODOT 160485 Pike Co.
- Sunbury Road
- Worthington Road
- ODOT 160426 Union Co.
- ODOT 170021 Franklin Co.
- ODOT 170040 Clark Co.
- ODOT 170064 Licking Co.
- Winchester Pike Franklin Co.
- Derr Road
- Cannelville Road
- UA Bridge Impov.
- Mound Street
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Select date
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Supervisor:
- None
- Paul Anderson
- Keith Baer
- Todd Green
- Jeremy Helton
- Rick Howard
- Dennis Lewis
- Charlie Lykins
- Stacey May
- Nick Murdock
- Bruce Osborne
- Tim Schmidt
- Aaron Young
- AJ Miracle
- Shane Murray
- Cliff Rinehart
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Supervisor #2:
- None
- Paul Anderson
- Keith Baer
- Todd Green
- Jeremy Helton
- Rick Howard
- Dennis Lewis
- Charlie Lykins
- Stacey May
- Nick Murdock
- Bruce Osborne
- Tim Schmidt
- Aaron Young
- AJ Miracle
- Shane Murray
- Cliff Rinehart
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Supervisor #3
- None
- Paul Anderson
- Keith Baer
- Todd Green
- Jeremy Helton
- Rick Howard
- Dennis Lewis
- Charlie Lykins
- Stacey May
- Nick Murdock
- Bruce Osborne
- Tim Schmidt
- Aaron Young
- AJ Miracle
- Shane Murray
- Cliff Rinehart
General Safety
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Bulletin Board
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SDS Book
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First Aid Kit
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Policy Book
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Site Specific Fall Protection Plan
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Emergency Action Plan
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Personal Protective Equipment
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Chemicals Labeleded
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Fire Extinguishers
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Drinking Water
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Additional Comments:
Housekeeping
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General Overall Appearance Acceptable
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Lunch Trash Picked Up
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Materials Organized and Stacked?
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Dumpster & Tool Shanty Acceptable
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Sanitation Facilities
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Additional Comments:
Fall Protection Items
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Fall Protection In use
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Fall Hazards Observed While On Site
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Walking/Working Surface Adequate
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Proper Handrail/Guardrail
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Any Open Holes Observed
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Area Clear Of Trip Hazards
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Proper Ladders Being Utilized
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PFAS Anchors Aqequate
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Harness and Lanyards Worn Properly
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Workers Tied Off in Manlift
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Rebar Caps In Place
Excavating & Trenching Items
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Competent Person Onsite
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Excavtions Shored Or Sloped?
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Trench Inspections Being Completed
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Proper Trench Box Being Utilized and Trench Box Data Onsite
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Ladder Located Every 25'
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Utilities Located
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Spore Piles 2' Away From Trench
Traffic Items
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Devices Properly Used and Aligned
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Stop/Go Paddle Being Utilized
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Proper Safety Clothing and Vests
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Traffic Control is Clear and in Good Condition
Equipment Items
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Back Up Alarms Working
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Cords in Good Condition
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Swing Radius for Crane Installed
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Welding Equipment Properly Stored
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Seat Belts Being Worn
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Equipment Being Greased And Cared For
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Life Vest/Rings & Boat Available
Other Safety Items:
Silica & Respirator Protection
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Respirator Medical Evals and Fit Test Completed
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Proper Respirator Equipment Being Utilized
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Is Silica Dust Being Abated Via An Approved Method
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Dustless Tools or Water Being Utilized
Heat Stress Management
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Signs of Heat Stress
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Crews Taking Appropriate Breaks
Equipment Inspections Completed
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Harness Inspections
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Lanyard Inspections
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Cables, Straps and Chains Inspections
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Heavy Machinery Inspections & Maintenance
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Crane Daily and Monthly Inspection Logs
Violations & Warnings
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Were Violations or Warnings Given During Inspection?
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Who:
Safety Meetings/Training
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Was a Safety Meeting or Training Conducted While on site?
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What Did It Cover?
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Upload Sign In sheet
Inspection Signature:
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