PRSI Job Site Safety - Pulv

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

On site Job Contact

• Name:

  Blank

• Phone #:

  Blank

Traffic Control

• Signs

  Safe

  At Risk

  N/A

• Flagmen/Escorts

  Safe

  At Risk

  N/A

• Pedestrian Hazards

  Safe

  At Risk

  N/A

• Traffic Flow

  Safe

  At Risk

  N/A

• Cones/Delineators<br>

  Safe

  At Risk

  N/A

• K-Rail

  Safe

  At Risk

  N/A

Underground Utilities

• Dig Alert #

  Yes

  No

  N/A

• Job walk completed

  Safe

  At Risk

  N/A

• Pothole Plan Reviewed

  Yes

  No

  N/A

• Utilities marked/located<br>

  Safe

  At Risk

  N/A

• Utility marks refreshed

  Safe

  At Risk

  N/A

• Any high hazard utility on site? Coordination with utility owner?

  Safe

  At Risk

  N/A

Vehicular Safety

• Parked Location of Company Vehicle - Cones?

  Safe

  At Risk

  N/A

• Vehicle Secure

  Safe

  At Risk

  N/A

• Fire Extinguisher

  Safe

  At Risk

  N/A

• Beacons

  Safe

  At Risk

  N/A

• Drive Cam camera

  Yes

  No

  N/A

• Truck Lights & Signals in working order (if being operated)

  Safe

  At Risk

  N/A

• Tires

  Safe

  At Risk

  N/A

• Condition of Cab Interior / Trash

  Safe

  At Risk

  N/A

PPE

• Safety Vests

  Safe

  At Risk

  N/A

• Hard Hats

  Safe

  At Risk

  N/A

• Safety Boots

  Safe

  At Risk

  N/A

• Compliant Eye Protection

  Safe

  At Risk

  N/A

• Hearing Protection

  Safe

  At Risk

  N/A

• Respiratory protection

  Safe

  At Risk

  N/A

• Long Pants

  Safe

  At Risk

  N/A

• Long Sleeves

  Safe

  At Risk

  N/A

• Spreader Truck Harness for Fall Protection

  Safe

  At Risk

  N/A

• Water / Coolers Clean

  Safe

  At Risk

  N/A

• Vendors Compliant

  Safe

  At Risk

  N/A

Program Applications

• Field Manual Available

  Safe

  At Risk

  N/A

• Tailgate Meeting Records

  Safe

  At Risk

  N/A

• Foreman's Awareness

  Safe

  At Risk

  N/A

Machine Safety

• Point Of Operation

  Safe

  At Risk

  N/A

• Maintenance & Leaking Of Fluids

  Safe

  At Risk

  N/A

• Safe Operator Station/Seat Belts

  Safe

  At Risk

  N/A

• Fire Extinguisher

  Safe

  At Risk

  N/A

• ROPS

  Safe

  At Risk

  N/A

• Back Up Alarm and Camera

  Safe

  At Risk

  N/A

• Safety Lift Locks

  Safe

  At Risk

  N/A

• Beacons

  Safe

  At Risk

  N/A

• Parking Brake

  Safe

  At Risk

  N/A

• Parking / Staging Location Approved

  Safe

  At Risk

  N/A

• Machine locked at end of shift

  Safe

  At Risk

  N/A

Unsafe Practices

• Unguarded Machinery

  Safe

  At Risk

  N/A

• Horseplay

  Safe

  At Risk

  N/A

• Improper Lifting Techniques

  Safe

  At Risk

  N/A

• Improper Work Procedures

  Safe

  At Risk

  N/A

• Not Using Safety Locks

  Safe

  At Risk

  N/A

Vehicles/Equipment Present

• Pickup/Service Trucks

  Yes

  No

  N/A

• Water Truck - Rental

  Yes

  No

  N/A

• Water Truck - PRSI

  Yes

  No

  N/A

• Spreader

  Safe

  At Risk

  N/A

• Compactor

  Safe

  At Risk

  N/A

• Pulverizer

  Safe

  At Risk

  N/A

• Cement/Lime Trucks

  Safe

  At Risk

  N/A

• Oil Tanker

  Safe

  At Risk

  N/A

• Other

  Safe

  At Risk

  N/A

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