Random Safety Audit

• Location
  Address

• Supervisor/Crew Leader

• Job description

• Conducted on

  Date

• Prepared by

• Personnel

Work order

• Tailgate safety topic is specific to the job performed

  Yes

  No

  N/A

• JHSA signed by all crew members

  Yes

  No

  N/A

• Pre job inspection done on equipment/vehicles

  Yes

  No

  N/A

Safety controls

• Crew is aware of all hazards and how to avoid them

  Yes

  No

  N/A

• LOTO done correctly

  Yes

  No

  N/A

• MSDS SHEETS CORRECT

  Yes

  No

  N/A

• All permits filled out correctly (Confined Space etc)

  Yes

  No

  N/A

• Barricade and tags properly placed

  Yes

  No

  N/A

• All PPE present and properly used

  Yes

  No

  N/A

• Is working area clean and free of hazards

  Yes

  No

  N/A

• Are ladders, scaffold, fall protection in use

  Yes

  No

  N/A

• Are the ladders, scaffolds, man lifts and fall protection being properly used

  Yes

  No

  N/A

Hydroblasting

• Whip checks in place

  Yes

  No

  N/A

• Blast hose inspected

  Yes

  No

  N/A

• Blast hose in good repair

  Yes

  No

  N/A

• 10k

• 20k

• 40k

Lancing

• Job on elevated floor.

  Yes

  No

  N/A

• Is blast hose properly tied off

  Yes

  No

  N/A

• Anti withdrawal device in place

  Yes

  No

  N/A

• Is anti-withdrawal device properly mounted

  Yes

  No

  N/A

• Is stinger and nozzle 1.5X the diameter of the pipe being cleaned?

  Yes

  No

  N/A

• Is lance in good repair

  Yes

  No

  N/A

• Is employee operating his own foot pedal

  Yes

  No

  N/A

• Is foot pedal in proper working order

  Yes

  No

  N/A

Shotgun

• Shotgun appropriate length

  Yes

  No

  N/A

• Does shot gun have a hose shroud

  Yes

  No

  N/A

Vacuuming

• Is job on an elevated floor

  Yes

  No

  N/A

• Is vac hose properly tied off

  Yes

  No

  N/A

• Is there a hose break in use

  Yes

  No

  N/A

• If necessary, is vac truck properly bonded

  Yes

  No

  N/A

Vehicle/equipment

• Is fire extinguisher in place and inspected

  Yes

  No

  N/A

• Is vehicle/equipment clean

  Yes

  No

  N/A

Observations

Corrective Action

• Auditor

  Sign

• Crew Leader/Supervisor

  Sign