PROMEDICA TOLEDO HOSPITAL NORTH CAMPUS NEUROSCIENCE LABS

• Audit Title

• Conducted on

  Date

• Prepared by

Site ( Trailer)

• Safety representative on site?

  Yes

  No

  N/A

• Emergency phone numbers posted?

  Yes

  No

  N/A

• First aid supplies accessible and stocked?

  Yes

  No

  N/A

• Eye wash station available and maintained?

  Yes

  No

  N/A

• Blood borne pathogen kit on site?

  Yes

  No

  N/A

• Fire extinguisher available?

  Yes

  No

  N/A

• Company Safety Health plan on site?

  Yes

  No

  N/A

• State Posters posted? ( OSHA, Workers Comp. , ext)

  Yes

  No

  N/A

• Training records including drug testing and tool box talks maintained?

  Yes

  No

  N/A

PPE

• Is minimum PPE being used on site including going to and from breaks, parking lot, etc?

  Yes

  No

  N/A

• Is the proper glove for the task being used?

  Yes

  No

  N/A

• Is hearing protection being used when required?

  Yes

  No

  N/A

• Are the proper color vests being worn for the task?( red for fire watch, ect)

  Yes

  No

  N/A

Facility Security and Public Safety

• Site perimeter fencing installed and maintained?

  Yes

  No

  N/A

• Warning signs placed where they are easily seen?

  Yes

  No

  N/A

• Travel and Access ways unobstructed and maintained?

  Yes

  No

  N/A

• Adequate lighting for site and the public?

  Yes

  No

  N/A

• Holes protected and clearly marked?

  Yes

  No

  N/A

• Traffic control plan in place?

  Yes

  No

  N/A

Housekeeping

• Adequate number of trash receptacles and are they maintained?

  Yes

  No

  N/A

• Material stored properly?

  Yes

  No

  N/A

• No exposed rebar, protruding nails, or other exposed hazards?

  Yes

  No

  N/A

• All the scrap and trash is removed from the work area and common area as soon as it is created?

  Yes

  No

  N/A

• Adequate number of bathroom facilities and hand wash stations?

  Yes

  No

  N/A

Fire Protection and Prevention

• Fire Prevention / Evacuation Plan communicated to all?

  Yes

  No

  N/A

• There is an adequate number of fire extinguishers of the proper type on site and inspected?

  Yes

  No

  N/A

• Hot Work is done by permit with Fire attendant posted for the minimum required time after hot work is complete?

  Yes

  No

  N/A

• Gas cylinders are stored properly with caps on and separated after use?

  Yes

  No

  N/A

• Every employee knows that this is a 100% NO SMOKING site and that there is a zero tolerable policy in place?

  Yes

  No

  N/A

• Fire hydrants are accessible to the authorities if needed?

  Yes

  No

  N/A

Fall Protection

• Proper guardrails are in place?

  Yes

  No

  N/A

• All openings / holes are covered or barricaded and clearly marked as "HOLE or COVER" with substantial covering to withstand 2x intended load?

  Yes

  No

  N/A

• Positioning devices being used when needed?

  Yes

  No

  N/A

• Personal fall arrest systems being used with 100% tie off with a 5000# capacity anchorage point?

  Yes

  No

  N/A

• Leading edge Protection?

  Yes

  No

  N/A

• Falling object Protection in place where overhead work in taking place?

  Yes

  No

  N/A

• All employees trained in the proper use, inspection, and storage of the personal fall arrest system?

  Yes

  No

  N/A

• 100% tie off at all times?

  Yes

  No

  N/A

Scaffolding

• Competent person designed the scaffold?

  Yes

  No

  N/A

• Anchored to the structure?

  Yes

  No

  N/A

• Proper access maintained?

  Yes

  No

  N/A

• Scaffold is plumb level and square with no defects visible?

  Yes

  No

  N/A

• Employees trained in the proper use of scaffolding system?

  Yes

  No

  N/A

• Scaffold has been inspected at least once per shift or after any modifications are made and the tag is correct for the application? ( green yellow or red )

  Yes

  No

  N/A

Electrical

• All power tools are inspected prior to each use and are in good working order?

  Yes

  No

  N/A

• GFCI receptacles used?

  Yes

  No

  N/A

• All cord and plugs that are damaged or defective are immediately taken out of service?

  Yes

  No

  N/A

• All cords and leads are elevated overhead or if on the ground protected from damage and clearly marked to avoid trip hazards?

  Yes

  No

  N/A

• Temporary lighting has adequate bulbs, none missing, and are not used for drop power?

  Yes

  No

  N/A

Hand and Power tools

• Tools inspected before each use?

  Yes

  No

  N/A

• All tools used properly and no home made tools on site?

  Yes

  No

  N/A

• All hoses are inspected prior to use and whip checks / safety pins used?

  Yes

  No

  N/A

• All tools have guards in place and are not modified?

  Yes

  No

  N/A

• All tools are properly stored when not in use?

  Yes

  No

  N/A

Cranes, hoists, and fork trucks

• Licensed / qualified operators with certifications on file?

  Yes

  No

  N/A

• All inspections complete? (Annual,daily,ect)

  Yes

  No

  N/A

• Load charts readily available?

  Yes

  No

  N/A

• Outriggers fully deployed with mats or using on rubber chart?

  Yes

  No

  N/A

• Swing radius Protection in place?

  Yes

  No

  N/A

• 10 ft min clearance from overhead power lines?

  Yes

  No

  N/A

• All Rigging is inspected prior to use?

  Yes

  No

  N/A

• Damaged Rigging taken out of service immediately?

  Yes

  No

  N/A

• Only qualified and trained employees acting as riggers?

  Yes

  No

  N/A

• Riggers identified by special color high via vest, and using audible warning when making pick?

  Yes

  No

  N/A

Heavy equipment and Arial lift platforms

• Only qualified and trained operators?

  Yes

  No

  N/A

• Equipment inspected before each shift and periodically throughout the shift?

  Yes

  No

  N/A

• Seat belts worn at all times?

  Yes

  No

  N/A

• Horns and back up alarms working and maintained?

  Yes

  No

  N/A

• 100% tie off while in lift?

  Yes

  No

  N/A

• Not using lift as a crane?

  Yes

  No

  N/A

• Not exceeding the max operating captivity?

  Yes

  No

  N/A

• Swing radius Protection in place?

  Yes

  No

  N/A

• Ground person while traveling in congested areas?

  Yes

  No

  N/A

Trenching and Excavations

• Utilities located and marked?

  Yes

  No

  N/A

• Adjacent structures stabilized?

  Yes

  No

  N/A

• Ladders / proper egress?

  Yes

  No

  N/A

• Barricades and warning signs in use?

  Yes

  No

  N/A

• Sloping and benching?(per OSHA tables)

  Yes

  No

  N/A

• Trench boxes used with certifications on file?

  Yes

  No

  N/A

• Inspected by competent person?

  Yes

  No

  N/A

• Permits in place to do excavation?

  Yes

  No

  N/A

Ladders

• Inspected daily?

  Yes

  No

  N/A

• Ladder Tied off or anchored and extend 3 feet above landing with 4:1 pitch being used?

  Yes

  No

  N/A

Welding and cutting

• Proper permit in place?

  Yes

  No

  N/A

• All debris removed from work area, trained fire watch with 25# ABC fire extinguisher in attendance?

  Yes

  No

  N/A

• Torch gauges hoses and gas cylinders are inspected prior to use?

  Yes

  No

  N/A

• Flash arrestors are in place?

  Yes

  No

  N/A

• Cylinders are kept upright and separated at least 20ft apart or with a 1/2 hour rated barricade with caps on when not in use?

  Yes

  No

  N/A

Hazcom

• Safety Data Sheets on site and available to all employees?

  Yes

  No

  N/A

• Employees trained in HAZCOM?

  Yes

  No

  N/A

• Proper containers and labels in use?

  Yes

  No

  N/A
• Add location
  Address

• Select date

  Date

• Add signature

  Sign