Ready Mix - Texas Materials Safety Audit

• Site conducted

  Select

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Previous Inspection

• Date of last inspection:

  Date

• Score:

• Description of discrepancy:

• Are there any outstanding actions?

  Yes

  No

LSR 1. Risk Assessment

• Risk Assessment Audit Questions:

• Is a Risk Assessment being completed?<br>

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Is there evidence of T-5s or other forms of safety meetings being conducted and documentation made available?<br>

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are emergency phone numbers posted near phones and kept up-to-date?<br>

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are SDSs up-to-date and readily available?<br>

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are first aid kits stocked with no expired products?<br>

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are first aid kits easily accessible?<br>

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Is a trained first aider available on site?<br>

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are the CRH Life Saving Rules posted?<br>

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are emergency lighting and exit signs routinely checked and properly maintained?<br>

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are all emergency exits in buildings properly identified?<br>

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are all emergency exits in buildings free of obstructions?<br>

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are radio communication with loaders and ground employees being utilized?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Do plant horns work for start up?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are control house Windows clear, with no obstructions to silos or load outs?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

LSR 9. Use of Personal Protective Equipment (PPE)

• PPE Audit Questions:

• Are hard hats being used?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are high visibility safety vests or shirts being worn?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are safety glasses or goggles being used?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are safety toe boots being worn?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Is hearing protection available and used when required?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are proper gloves available and worn when required?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are loose clothing, adornments, and hair suitably controlled/confined to prevent entanglement with any machinery and device?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are all PPE being worn in good condition?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are dust masks made readily available?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Does the supervisor/foreman have extra PPE?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Is the appropriate PPE made available for welding?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

Arc Flash Required PPE

• Arc Flash PPE Audit Questions:

• Is flash resistant clothing, coveralls or uniform in good condition and readily available?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Is Arc Flash hard hat with face shield in good condition and readily available?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Is adequate gloves made available with Arc Flash equipment in good condition?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Document date on gloves:

LSR 3. Isolation of Operating Machinery and Electrical Safety

• LOTO Audit Questions:

• Is Lockout/Tagout manual/policy up-to-date and being used properly?<br>

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are valves covers and lockout equipment devices available?<br>

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Does each employee have their own lock?<br>

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

Mobile Equipment During Maintenance

• LOTO for Mobile Equipment

• Are steering wheel covers and other lockout equipment devices available and being used?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are wheel chocks and jack stands available and used?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

Electrical Safety

• Electrical Audit Questions:

• Is all of the electrical wiring free of damage and fray?<br>

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are extension cords in good condition?<br>

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are electrical equipment operating between 50 and 600 volts protected against accidental contact by an approved cabinet or other enclosure?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are GFCI provided on outlets around water and all extension cords?<br>

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Is there a 3 foot clearance around electrical boxes?<br>

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are all electrical panels, breakers and disconnect boxes identified properly with Arc Flash labels?<br>

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are disconnects labeled to show what they control?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are permanent splices in cable insulated, in good condition, and sealed from moisture?<br>

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are electrical cords across walk-ways protected/covered?<br>

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Is there permanent wiring used in place of extension cords?<br>

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are all electrical switches, breakers, etc. properly labeled for what they operate?<br>

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Is the Motor Control Center (MCC) entrances clearly identified as DANGER and restricted to authorized personnel?<br>

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Is there sufficient access and working space provided and maintained around all electrical equipment including access to disconnect devices?<br>

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are there no extraneous combustible/ flammable materials stored in MCC rooms?<br>

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

Fire Protection/ Prevention

• Fire Safety Audit Questions:

• Are smoke detectors working properly?<br>

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are carbon monoxide detectors working properly, if applicable? Mechanic Shops, Offices Connected to Shops, Where Fuel Burners are used, etc.

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are fire extinguishers strategically located?<br>

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are all of the fire extinguishers visible and accessible?<br>

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Do fuel dispensing areas have proper signage and adequate fire suppression readily avaliable?<br>

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are monthly fire extinguisher inspections being logged?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are "no smoking" signs/ labels posted around flammable materials?<br>

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are flammable liquids stored in approved safety cans and containers?<br>

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are containers of flammable/ combustible materials stored in a flammable storage cabinet or other isolated areas and proper signage in place?<br>

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are flammable storage areas vented properly?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are spill kits/ absorbent available?<br>

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

LSR 6. Working at Heights

• Working at Heights Audit Questions:

• Is fall protection in good working condition?<br>

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• *Are employees/ subcontractors working above 6 feet?<br>

  Yes

  No

• Are employees/ subcontractors equipped with adequate fall protection?<br>

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are all ramps bermed half the distance of the largest equipment being used on ramps?<br>

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are chains or self-closing gates in use at top of all Fixed Vertical Ladders (FVLs)?<br>

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are all FVL more the 19 feet' in length equipped with cage that extends at least 36 inches above the landing & starts not more than 7 feet from the bottom of the ladder, or are equipped with center-line fall protection?<br><br>

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• If an employee is working from heights, is the area below barricaded-off half the distance they are working from?<br>

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

Ladders

• Ladder Safety Audit Questions:

• Are ladders in good condition without damages?<br>

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are ladders being inspected before each use?<br>

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are ladders being inspected monthly? (Monthly inspection stickers in place and up-to-date.)<br>

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are labeling/marking on ladders legible?<br>

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Do all ladders have the capacity rating posted?<br>

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Do all portable ladders have safety feet?<br>

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

Stairs and Walkways

• Stairs and Walkways Audit Questions:

• All stairs and walkways in good working conditions?<br>

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are proper height on all handrails, at least 42 inches?<br>

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are swing gates installed on all working platforms?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are non-slip mats, gratings, false floors, and other like materials used in areas where slipping is a concern?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are all mats, grates, etc. in good repair?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are there toe boards on all walkways?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Do toe boards meet specifications and in good repair?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are housekeeping practices carried out to ensure work areas are safe from trip/fall hazards to employees?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

LSR 10. Safety of Materials Under Pressure

• Safety of Materials Under Pressure Audit Questions:

• Are all compressed gas cylinders secured in safe manner and properly capped when not in use?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are oxygen cylinders stored away from flammable materials and at least 25 feet from flammable gas cylinders?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are required inspections performed on all pressure vessels/ compressors?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are storage areas for cylinder bottles labeled, "Full" or "Empty"?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Does all high pressure lines have the approved high pressure clamp? No radiator clamps?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Is compressed air used for cleaning purposes regulated to 30 pounds?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

LSR 7. Lifting Operations

• Lifting Operations Audit Questions:

• Do all lifting implements such as straps, cables and chains have their load limit identified, as applicable?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are lifting hoists inspected prior to each use with proper load limits posted?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are employees only lifting objects less than 50 pounds on their own?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are all hooks equipped with safety latches in good condition?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

LSR 4. Machine Guarding

• Machine Guarding Audit Questions:

• Are all points-of-operations and pinch points guarded?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Is their barrier guards on moving machinery parts?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are all floor holes, floor openings, hatchways, manholes, wall openings, and skylights properly guarded?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are all open sided floors, platforms and runways four feet or more above ground or floor level properly guarded and have toe boards?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are belts/pulleys enclosed?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are light bulbs guarded?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are all belts and pulleys within 42 inches from the ground fully guarded?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are all conveyor systems within 7 feet of walking/working surface equipped with a shut-off cable or guard?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are auto start systems are identified by signage and have audible or visual alarms to warn employees in the area?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• * Is there maintenance of silos occurring?

  Yes

  No

• Are barricades used under silo drop gate?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

Hot Work

• Hot Work Audit Questions:

• Are welding operations screened to prevent flash injuries?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are extra fire extinguishers present for welding operations?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Is proper eye protection being worn for work being done?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

Mobile Plant Safety

Pedestrian/Vehicle Segregation

• Pedestrian/ Vehicle Segregation Audit Questions:

• Are traffic flow signs posted, positioned appropriately and visible?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are the appropriate signs in place around site? (Phone use, do not enter, speed limit, crossing)

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Is there a Pedestrian Segregation written plan in place?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

Mobile Equipment

• Mobile Equipment Audit Questions:

• Are daily pre-use equipment inspections being done?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Is there a 3-Points of Contact decal in place on steps of all equipment?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are wheel chocks made available and used when required?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Do employees understand and comply with the mobile phone policy?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Do all pieces of mobile equipment have slow moving vehicle signs, strobe light, and reflective tape?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Single Equipment Audit: (At a minimum, add one piece of equipment to the audit.)

Equipment

• Equipment Number:

• Is the equipment operator qualified?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Is the Operator Manual present?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Is good housekeeping practices being used in cab equipment?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are seat and seat belts in good condition?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are mirrors adjusted properly and in good condition?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Does the back-up alarm work properly?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are access steps and railing in good working condition?<br>

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are parking brakes capable of holding mobile equipment with typical load on max grade?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

Company Vehicles

• Single Company Vehicle Audit: (At a minimum, add one company vehicle to this audit)

Company Vehicle

• Company Vehicle Number:

• Is the vehicle kept clean?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are tires in good condition, and have good tread depth?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are mirrors in good working condition?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Does the driver have current proof of insurance and vehicle registration?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are seat belts in good condition?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

LSR 5. Confined Space Entry

• Confined Space Audit Questions?

• Is the Confined Space Manuel in place and being used properly?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Is the Confined Space Monitor being calibrated and logged before use?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are bump tests being performed before each entry and logged?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are all confined space areas properly labeled?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

Housekeeping

• Housekeeping Audit Questions:

• Is the site practicing good housekeeping in all buildings?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are microwaves and refrigerators maintained in a sanitary and safe operational condition?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Is the site practicing good housekeeping of restrooms?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Is portable restrooms provided on-site if needed and maintained?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Is the site practicing good housekeeping throughout the site?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are outside storage areas in good condition?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are garbage containers provided and used?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Is the entrance to the yard and office clean and tidy?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are all containers labeled and labeled correctly?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are eyewash stations easily accessible and maintained?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

Housekeeping

• Housekeeping Audit Questions:

• Are all containers used to catch oil covered and or not exposed to the weather?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Is containment in good condition with no leaks and cracks?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are there no stains on the ground around the site that need to be cleaned up? (Check by fuel stations)

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are areas where water runoff water leaves the site free of visible silt or containment laden runoff? (Use site map to locate these areas)

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Is cement truck wash station kept as clean as possible?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are dumpsters being kept closed?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are all reasonably accessible areas immediately downstream of each outfall?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Is there evidence of offsite tracking of materials or sediment?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Is wind blown trash being removed and placed in trash containers?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are Used Oil tanks properly labeled as "Used Oil"? (should not be labeled as Waste Oil)

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are all on-site containers, containing fluids, labeled as to their content?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Are SDSs available for contents of all containers on-site?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• *Does facility have proper structural controls? (berms, ponds)

  Yes

  No

• Is structural controls effective and maintained?

  Not Compliant

  In-Progress

  Compliant

  Best Practice

  Not Applicable

• Major concerns

concerns

• Description:

• Photos to aid with description:

  Media

• *Overall how do you rate the upkeep of the facility? (10 being excellent)

Documentation On File

• Documentation Audit Questions:

• Where are Weekly Safety Talks including roster and materials kept?

  At Local Safety Office

  On-site

  N/A

• Is there proof of all employees operating equipment being trained on-site or at local safety office?

  Yes

  No

  N/A

• Is there proof of all drivers being trained in the company safe driving programs (DDC or Smith System)?

  Yes

  No

  N/A

• Is there documentation of all required employees completing LOTO training on-site or at local safety office?

  Yes

  No

  N/A

• Is there documentation for all required employees who perform confined space entrance completing required training on-site or at local safety office?

  Yes

  No

  N/A

• Is there proof of all employees completing fall protection on-site or at local safety office?

  Yes

  No

  N/A

• Is there documentation that employees have received rigging and lifting training on-site or at local safety office?

  Yes

  No

  N/A

• Is there documentation that employees have received pressurized system training on-site or at local safety office?

  Yes

  No

  N/A

• Is there proof of employee engagement in Near Miss reporting, behavior observations, and/or mentoring program on-site or at local safety office?

  Yes

  No

  N/A

• Other unsafe behaviors and conditions observed:

Unsafe observation

• Description of observation:

• Pictures to aid in observation:

  Media

• Overall how do you rate the overall safety of the site 10 being fully compliant? (Please add comments to better aid site manager/staff)

• Check the box to approve that the above audit was done by a Safety Representative?

• Safety Representative Signature:

  Sign

• Title:

• Have the Site Manager or Site Representative check the box, agreeing that they received a briefing after the completion of the audit.

• Site Manager/Site Representative Signature:

  Sign

• Title: