QualSafe Audit

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  Media

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

1. Administration

• 1.1. OSHA Posters/OSHA 300 Form Posted (Feb 1st - April 30th)

  Yes

  No

  N/A

• 1.2. Superintendent's Daily Inspection Log

  Yes

  No

  N/A

• 1.3. Safety Meetings Documented

  Yes

  No

  N/A

• 1.4. Safety Manual Present

  Yes

  No

  N/A

• 1.5. MSDS Present

  Yes

  No

  N/A

2. Medical/Emergency

• 2.1. Emergency Numbers Posted

  Yes

  No

  N/A

• 2.2. Map of Medical Locations Posted

  Yes

  No

  N/A

• 2.3. First Aid Kit

  Yes

  No

  N/A

• 2.4. Eye Wash Station

  Yes

  No

  N/A

• 2.5. Emergency Action Plan

  Yes

  No

  N/A

• Comments:

3. PPE

• 3.1. Hard Hats

  Safe

  At Risk

  N/A

• 3.2. Glasses/Goggles/Face Shields

  Safe

  At Risk

  N/A

• 3.4. Proper Clothing

  Safe

  At Risk

  N/A

• 3.5. Proper Work Boots worn

  Safe

  At Risk

  N/A

• 3.6. Proper Hearing Protection

  Safe

  At Risk

  N/A

• Comments:

4. Fall Protection

• 4.1. 100% Tie-Off above 6'

  Safe

  At Risk

  N/A

• 4.2. Proper Attachment Points

  Safe

  At Risk

  N/A

• 4.3. Floor/Wall Openings Covered

  Safe

  At Risk

  N/A

• 4.4. Guardrail System in place

  Safe

  At Risk

  N/A

• 4.5. Roof Edge Protected

  Safe

  At Risk

  N/A

• Comments:

5. Electrical

• 5.1. GFCI Used

  Safe

  At Risk

  N/A

• 5.2. Cords Inspected

  Safe

  At Risk

  N/A

• 5.3. Cords Protected from Traffic and Weather Exposure

  Safe

  At Risk

  N/A

• 5.4. Lockout/Tagout Used

  Safe

  At Risk

  N/A

• 5.5. Cover & Proper Signage Present

  Safe

  At Risk

  N/A

• Comments:

6. Scaffolding

• 6.1. Competent Person on Site

  Safe

  At Risk

  N/A

• 6.2. Assembled Properly

  Safe

  At Risk

  N/A

• 6.3. Inspected Daily

  Safe

  At Risk

  N/A

• 6.4. Guardrail/Bracing/Pins

  Safe

  At Risk

  N/A

• 6.5. Proper Footing and Access to Platform

  Safe

  At Risk

  N/A

• Comments:

7. Scissor/Aerial Lifts

• 7.1. Gate/Chains Secured/100% Tie-Off

  Safe

  At Risk

  N/A

• 7.2. Guardrails Erected Properly

  Safe

  At Risk

  N/A

• 7.3. Operating on a Flat Surface

  Safe

  At Risk

  N/A

• 7.4. Safe Operating Wind Speed

  Safe

  At Risk

  N/A

• Comments:

8. Excavations

• 8.1. Utilities Marked

  Safe

  At Risk

  N/A

• 8.2. Properly Shored/Sloped

  Safe

  At Risk

  N/A

• 8.3. Spoil >2' from Excavation

  Safe

  At Risk

  N/A

• 8.4. Perimeter Protection

  Safe

  At Risk

  N/A

• 8.5. Proper Access/Egress (<25' Lateral Travel)

  Safe

  At Risk

  N/A

• 8.6. Inspection Completed and Documented by Competent Person

  Safe

  At Risk

  N/A

• Comments:

9. Fire Protection

• 9.1. Extinguisher Present, Charged, & Inspected

  Safe

  At Risk

  N/A

• 9.2. Adequate Number of Extinguishers

  Safe

  At Risk

  N/A

• 9.3. Fire Watch Used where needed

  Safe

  At Risk

  N/A

• 9.4. Proper Fuel Containers used

  Safe

  At Risk

  N/A

• 9.5. "No Smoking" in Flammable & Hazardous Storage

  Safe

  At Risk

  N/A

• Comments:

10. Ladders

• 10.1. Properly Secured

  Safe

  At Risk

  N/A

• 10.2. Proper Ladder used

  Safe

  At Risk

  N/A

• 10.3. Used around Electrical Hazards

  Safe

  At Risk

  N/A

• 10.4. Inspected for Defects

  Safe

  At Risk

  N/A

• 10.5. Ladders Extend 3' Above Landing Surface

  Safe

  At Risk

  N/A

• 10.6. Area around Top & Bottom of Ladder free of Tripping Hazards

  Safe

  At Risk

  N/A

• Comments:

11. Welding/Cutting

• 11.1. Oxygen/Acetylene Capped

  Safe

  At Risk

  N/A

• 11.2. Cylinders Upright and Secured

  Safe

  At Risk

  N/A

• 11.3. Flash Arrestors on Cylinders

  Safe

  At Risk

  N/A

• 11.4. Leads and Hoses Free of Defects

  Safe

  At Risk

  N/A

• 11.5. Proper PPE Used

  Safe

  At Risk

  N/A

• 11.6. Welding Screens in use

  Yes

  No

  N/A

• Comments:

12. Cranes & Hoisting Equipment

• 12.1. Load Chart & Boom Angle Indication

  Safe

  At Risk

  N/A

• 12.2. Critical Lifts Properly Planned

  Safe

  At Risk

  N/A

• 12.3. Equipment Properly Supported (Outriggers/Pads used)

  Safe

  At Risk

  N/A

• 12.4. Power Lines Inactivated, Covered, or at a Safe Distance (No Closer than 20')

  Safe

  At Risk

  N/A

• 12.5. Swing Radius of Cranes Barricaded

  Safe

  At Risk

  N/A

• 12.6. Annual Crane Inspection Verified

  Safe

  At Risk

  N/A

• 12.7. Rigging (Slings, Chains, Straps)

  Safe

  At Risk

  N/A

13. Environmental

• 13.1. Asbestos, Lead, Mold, or Silica Concerns

  Safe

  At Risk

  N/A

• 13.2. Nuisance Dust and/or Noise Controls in place

  Safe

  At Risk

  N/A

• 13.3. Containers, Drums, & Tanks are properly Labeled

  Safe

  At Risk

  N/A

• 13.4. Spill Containment is Adequate for Hazardous Materials

  Safe

  At Risk

  N/A

• 13.5. Any Hazardous Materials Apparent (Ignitable, Corrosive, Reactive, or Toxic

  Safe

  At Risk

  N/A

• Comments:

14. General

• 14.1. Housekeeping Adequate

  Safe

  At Risk

  N/A

• 14.2. Adequate Access/Egress

  Safe

  At Risk

  N/A

• 14.3. Adequate Lighting

  Safe

  At Risk

  N/A

• 14.4. Adequate Ventilation

  Safe

  At Risk

  N/A

• 14.5. Sanitary & Washing Facilites

  Safe

  At Risk

  N/A

• 14.6. Tools in proper working order/guards in place

  Safe

  At Risk

  N/A

• 14.7. Impalement Protection in place

  Safe

  At Risk

  N/A

• 14.8. Equipment Back-Up Alarms properly working

  Safe

  At Risk

  N/A

• 14.9. Seat Belts

  Safe

  At Risk

  N/A

• Comments:

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• On-Site Representative

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• Auditor's Signature

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