Information
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Document No.
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Audit Title
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Conducted on
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Observed by:
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Task Observed?
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Location
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Personnel
Personal Protective Equipment (Proper Use, Storage, and Maintenance)
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Hands protected when working with tools, sharp objects, chemicals, hot or cold items?
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Eyes/face protected from flying debris, chemicals and radiant light. Safety glasses worn in mandatory areas?
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Head protected from impact from objects above and at same height?
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Feet protected from impact, puncture, electrical?
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Ice cleats in use while performing snow removal?
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Fall protection used properly?
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Hearing protection used in mandatory areas?
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Respiratory protection for vapors, dust, misc. debris.
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Clean shaven, mask stored in sealed container?
Body Position
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3 Points of contact while ascending/descending ladders or stairs?
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Using proper Lifting / Twisting technique?
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Protected from Line of fire? Caught-in, Struck by, Energy Release
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Workers keeping hands out of danger zone?
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Workers staying focused...Eyes on path?
Tools
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Proper Ladders / Scaffolds / Aerial Lifts being used?
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Proper equipment Selection / Use the proper tool?
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Tools in Good Condition / Proper Guarding?
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GFCI in use with portable equipment?
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Electrical cords inspected for risks? Protected from damage?
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Temporary power is being used properly?
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Flammable materials removed when using electrical tools?
General Safety
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Housekeeping - Area free of unnecessary materials?
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Flammable and combustibles stored properly?
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Ladder/stairways clear of materials and debris?
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Egress unobstructed?
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Using handrails on stairways?
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Surface conditions evaluated and controlled (Ice/Oil/Uneven surfaces??
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Employees know where the nearest fire extinguisher is?
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Employees know the emergency procedures?
Other
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Employees aware of chemical hazards?
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Radiation controls in place?
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Employees following work-zone traffic controls for Roadside work?
Lifting Equipment
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Employees trained and using Overhead cranes / hoists properly?
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Employees trained and using forklifts properly?
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Are the Slings / Rigging being used rated for the intended load?
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Mobile cranes are set up/used correctly?
Construction Area
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Traffic Control systems constructed appropriately?
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JHA completed (if needed)?
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Controls in place while working from heights?
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Barricades / Signs in place?
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Permits completed and available (if needed)?
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Excavation area controlled? Employees using proper trench shoring/shielding?
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Are employees accessing trench appropriately? (ladders, ramps)
Confined Space Entry
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Permit completed and posted?
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Attendant performing his duties only?
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Air Monitoring being completed?
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PPE / Emergency Equipment in use?
Lockout / Tagout / Linebreak
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Employees using personal Locks / Tags?
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Equipment properly De-energized?
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Employees have knowledge of Procedure?
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Proper PPE (Goggles, Face Shield, Gloves for Arc Flash?
Hot Work
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Permit completed and Posted?
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Fire watch with extinguisher assigned?
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Work area free of flammables and combustibles?
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PPE in use (Welding hood, Screen)?
Vehicle Safety
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Wheel chocks in place?
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3 points of contact while Entering / Leaving Vehicle?
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Pre trip inspections completed?
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Proper Loading / Unloading (away from power lines/using hand trucks/lift gates?
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All loads are secured?
Office Safety
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Housekeeping?
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Cords (Electrical Hazards)?
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Trip hazards?
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Positive comments / safety topic communicated (provide detail):
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Opportunities:
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Signature