QTC Inc. Telecom Site Safety Audit Form -

• Job Name/Number

• Job Address

• Geotag
  Address

• Job Superintendent/Foreman

• QTC Employees on site

• Conducted on

  Date

• Prepared by

Program Administration

• Is the QTC Safety Banner hung up at site entrance?

  Yes

  No

  N/A

• Picture of QTC banner or Billboard

  Media

• Is the QTC IIPP /Codes of Safe Practices book available for review?

  Yes

  No

  N/A

• Is the QTC Safety Manual on-site?

  Yes

  No

  N/A

• Has the QTC Daily Job Site Safety Analysis (JSA) been filled out?

  Yes

  No

  N/A

• Has every employee on site reviewed and signed the JSA?

  Yes

  No

  N/A

• Does the JSA cover all hazards in detail. (tools, lifts, falls, scaffolds, RF exposure, etc.)

  Yes

  No

  N/A

• Is the Emergency Action Plan filled out?

  Yes

  No

  N/A

• Is the QTC Emergency Calling Tree available?

  Yes

  No

  N/A

• Has the Weekly Tailgate Meetings been completed with individual signatures of each person on site?

  Yes

  No

  N/A

• Has all applicable inspection forms been completed? (equipment operator inspection, trench inspection, etc.)

  Yes

  No

  N/A

• Is drinking water available on site?

  Yes

  No

  N/A

• Deficiencies Found

Medical

• Is an ANSI rated 1st Aid Kit available and properly stocked?

  Yes

  No

  N/A

• Picture of first aid kit in accessible and visible location

  Media

• Is there at least two certified 1st Aid/CPR trained employees on site?

  Yes

  No

  N/A

Fire prevention and protection

• Is there type ABC fire extinguisher(s) readily available for immediate use on site?

  Yes

  No

  N/A

• Is there a fire extinguisher available for each separate work area? (i.e. rooftop and lower level equipment room)

  Yes

  No

  N/A

• Picture of fire extinguisher(s) in accessible and visible location

  Media

• Are flammable liquids stored in metal safety cans and properly labeled?

  Yes

  No

  N/A

• Picture of Flammable liquid storage

  Media

• Are all work areas clear of combustible scraps and debris?

  Yes

  No

  N/A

• Are all emergency exit pathways kept clear?

  Yes

  No

  N/A

• Are fire lanes kept clear so emergency vehicles can enter the site?

  Yes

  No

  N/A

• Deficiencies Found

Personal protective equipment

• Is proper personal protective equipment being used when required?

  Yes

  No

  N/A

• Are Hard Hats being worn at all times?

  Yes

  No

  N/A

• Picture of hardhats being worn

  Media

• Are all employees wearing Z-87 Safety Glasses on site?

  Yes

  No

  N/A

• Are safety glasses appropriate for lighting conditions?

  Yes

  No

  N/A

• Is the RF Monitor present and being used? Calibration within dates?

  Yes

  No

  N/A

• Is face protection being used when needed? Face shields for grinders or chop saws.

  Yes

  No

  N/A

• Is proper footwear being worn by all personnel?

  Yes

  No

  N/A

• Is hearing protection being used when needed?

  Yes

  No

  N/A

• Is respiratory protection being used when needed?

  Yes

  No

  N/A

• Is fall protection being used when required? (exposure to falls of 6 feet or greater to a lower level)

  Yes

  No

  N/A

• Are personnel using cut resistant gloves when handling sharp/rough material or tools?

  Yes

  No

  N/A

• Are all employees wearing long pants and shirts with minimum 4 inch sleeves?

  Yes

  No

  N/A

• Deficiencies Found

Ladders

• Is the proper ladder for the job being used?

  Yes

  No

  N/A

• Picture of ladders

  Media

• Are ladder inspections being performed?

  Yes

  No

  N/A

• Are ladders in good condition (no missing or broken rungs)?

  Yes

  No

  N/A

• Metal ladders are NOT being used?

  Yes

  No

  N/A

• Multi purpose, adjustable ladders are NOT being used?

  Yes

  No

  N/A

• Are defective ladders immediately withdrawn from service and marked "do not use" or destroyed?

  Yes

  No

  N/A

• Is 100% fall protection being used for working on ladders greater than 6 feet in height?

  Yes

  No

  N/A

• Deficiencies Found

• Are step ladders on site?
  

Ladders

• Are step ladders fully open when in use?

  Yes

  No

  N/A

• Is employee not standing on top two rungs of step ladder?

  Yes

  No

  N/A

• Are extension ladders on site?

Extension ladders

• Are extension ladders being set up at a 4 to 1 ratio?

  Yes

  No

  N/A

• Are extension ladders tied off or secured at top?

  Yes

  No

  N/A

• Do siderails extend 36 inches above the top of opening or has a handgrip been put in place 36 inches high?

  Yes

  No

  N/A

Scaffolding

• Is scaffolding on site?

Scaffolding

• Has scaffolding been erected correctly?

  Yes

  No

  N/A

• Picture of scaffolding

  Media

• Is scaffold erected on a firm and substantial surface?

  Yes

  No

  N/A

• Are scaffolds fully planked?

  Yes

  No

  N/A

• Are toeboards and guardrails in place on scaffolding?

  Yes

  No

  N/A

• Is a green tag in place and signed by a certified competent erector on all scaffolds? (scaffold company erector green tag)

  Yes

  No

  N/A

• Are workers tied off by an independent vertical life line while on yellow tagged scaffold?

  Yes

  No

  N/A

• Is the Solex daily inspection tag in place and signed by the supervisor for everyday the scaffold is being used.

  Yes

  No

  N/A

• Deficiencies Found

• Is there rolling scaffolding (baker type) on site?

Rolling scaffolding

• Do rolling scaffolds have locking wheels and are locked when used?

  Yes

  No

  N/A

• Picture of rolling scaffold (baker type)

  Media

Tools

• Are the power tools with cords on site?

Power tools

• Are cords in good condition not frayed, damaged or missing ground pins?

  Yes

  No

  N/A

• Picture of tools

  Media

• Are handles, shields, and guards on all tools in good condition and being used correctly?

  Yes

  No

  N/A

• Are hoses on air or hydraulic tools in good condition and attached securely?

  Yes

  No

  N/A

• Does air tools have automatic air shut off for accidental release or whip ties at connections joints to prevent whip action?

  Yes

  No

  N/A

• Deficiencies Found

Electrical

• Is electrical lockout/tag out needed?

Lockout

• Are all switch panels and devices that are energized marked and guarded to prevent accidental contact?

  Yes

  No

  N/A

• Are lockout devices used on all circuits that could become energized while work is being performed?

  Yes

  No

  N/A

• Do all employees working on the circuit have control over the lockout device?

  Yes

  No

  N/A
Is live electrical work being completed?

• Is live electrical work being completed by certified licensed electricians or Specific Equipment Qualified Persons (SEQP)?

  Yes

  No

  N/A

• Are rated insulated tools being used?

  Yes

  No

  N/A

• Is proper NFPA 70E category electrical PPE being worn?

  Yes

  No

  N/A

• Are fish tapes non-metallic?

  Yes

  No

  N/A

• Is there temporary electrical supply on site?

Temp Electrical

• Is temporary lighting per the electrical wiring standard? (proper flexible cords, junction boxes or receptacles, no exposed wire nuts, etc.)

  Yes

  No

  N/A

• Are all temporary lights in work areas and supply trailers protected with guard? Are guards closed, bulbs in place, and not burned out?

  Yes

  No

  N/A

• Picture of temp lighting

  Media

• Is temporary lighting hung by non-conductive material?

  Yes

  No

  N/A

• Deficiencies Found

• Are temporary receptacles affixed to walls or stands? (wall mounted, spider box, etc.)

  Yes

  No

  N/A

• Are there any visual signs of outlet overloading?

  Safe

  At Risk

  N/A

• Are temporary circuits properly guarded and grounded with GFCI protection?

  Yes

  No

  N/A

• Is there any job made outlets with extension cords affixed? (these type are not allowed and must be removed, only UL Listed types rated for hard usage)

  Yes

  No

  N/A

• Are extension cords on site?

Extension Cords

• Are OSHA approved type extension cords being used on job site? Only UL Listed, rated at a minimum, HARD USAGE, no general type allowed.

  Yes

  No

  N/A

• Are extension cords being correctly used? They are not fastened with staples, hung from nails, or suspended by wire?

  Yes

  No

  N/A

• Are extension cords not damaged, frayed, missing ground pins, and are of the three wire type?

  Yes

  No

  N/A

• Do all cords have ground prongs and are not bent or broken?

  Yes

  No

  N/A

• Are all extension cords protected by GFCI at source of power?

  Yes

  No

  N/A

• Are extension cords protected from sharp edges and doorways? (i.e. protective sleeves at doorways or over metal stud track)

  Yes

  No

  N/A

Trenching and excavation

• Is there currently trenching and excavation taking place on site?

Trenching and Excavation

• Do the subs have a competent person on site when deeper than 4 feet?

  Yes

  No

  N/A

• Has the competent person form for trenches deeper than 4 feet been signed?

  Yes

  No

  N/A

• Are all trenches and excavations properly barricaded? (i.e. danger/caution tape with delineators)

  Yes

  No

  N/A

• Does trenches have floor coverings at access/egress walk paths supporting at minimum 400 lbs.?

  Yes

  No

  N/A

• Picture of trenches

  Media

• Is all excavated material properly stored 2 feet or more from edge?

  Yes

  No

  N/A

• In trenches more than 4 feet deep, are ladders within 25 feet travel distance?

  Yes

  No

  N/A

• Is protective shoring or trench boxes in place for trenches deeper than 4 feet?

  Yes

  No

  N/A

• If shoring or boxes are in place, is the tabulated data available on-site?

  Yes

  No

  N/A

• Is proper sloping being used for trenches?

  Yes

  No

  N/A

• Deficiencies Found

Welding

• Is Welding/soldering currently taking place?

Welding

• Has a hot work permit been obtained and on-site?

  Yes

  No

  N/A

• Is a fire extinguisher within range of welding/soldering work?

  Yes

  No

  N/A

• Are fire blankets being used where needed?

  Yes

  No

  N/A

• Are all shields, helmets and goggles in place and in good condition?

  Yes

  No

  N/A

• Picture of PPE for Welding

  Media

• Have all cylinders been chained upright with valve caps in place?

  Yes

  No

  N/A

• Are hoses and gauges in good working order?

  Yes

  No

  N/A

• Are inspections for fire hazards be done when welding is completed?

  Yes

  No

  N/A

• Deficiencies Found

General

• Are competent person forms for each sub on site?

  Yes

  No

  N/A

• Are proper housekeeping procedures being performed daily?

  Yes

  No

  N/A

• Are all tools and materials properly stored and placed so as not to produce slip or trip hazards?

  Yes

  No

  N/A

• Are all openings in floors and walls through which employees can fall protected?

  Yes

  No

  N/A

• Are all holes covered, secured, and marked?

  Yes

  No

  N/A

• Are rebar caps in place when needed?

  Yes

  No

  N/A

• Picture of rebar caps

  Media

• Are sanitary systems and supplies available and adequate?

  Yes

  No

  N/A

• Is adequate lighting provided in all work areas?

  Yes

  No

  N/A

• At night is jobsite secure so that unauthorized persons are not at danger from tools, equipment and materials?

  Yes

  No

  N/A

• Are subcontractors being notified in writing when violations are found?

  Yes

  No

  N/A

• Deficiencies Found

• Are copies of notifications being kept in jobsite safety manual?

  Yes

  No

  N/A

• Notes

• undefined

• Subcontractors on site today

• undefined

• Picture of violation

  Media

• Picture of violation

  Media