Title Page

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Supervision

  • FALL HAZARDS

  • GENERAL FALLS

  • Floor openings covered/guard rails in place?

  • Roof edge adequately guarded?

  • All horizontal lifelines engineered?

  • Leading edge protection and signage in place?

  • PFA's worn properly, 100% protection, inspected?

  • Employee's protected from fall exposures 6+ feet?

  • LADDERS

  • Secured at top and bottom?

  • Extended 36" above landing?

  • Rails and rungs in good repair?

  • Step ladder in good repair, used properly?

  • STAIRS

  • Stairways clear from tripping hazards?

  • Metal pans poured, filled, or barricaded from use?

  • Handrails installed on stairways and landings?

  • SCAFFOLDING

  • Scaffolding inspected?

  • Scaffolding plumb?

  • Scaffolding tied at 4x the base dimension?

  • Mud sills provided?

  • Guard rails, mid-rails, toe boards, and feet installed?

  • Fully planked?

  • Power lines inactive, removed or at a safe distance (20' from scaffold)

  • AERIAL LIFTS/MAN LIFTS

  • Tied off in articulating boom lift?

  • Chain closed on scissor lift?

  • Training verified? Being operated safely?

  • Power lines safe or at a safe distance (20+ feet)?

  • Protection from drop offs and holes?

  • CAUGHT IN-BETWEEN

  • EXCAVATIONS

  • Written daily inspections done by Competent Person?

  • Shored, sloped, or benched 1.5:1 unless can prove better soil type?

  • Tabulated data on site?

  • Slope toe is 18" below trench box?

  • Trench box max 2, above bottom of trench?

  • Trench boxes not damaged or missing parts?

  • Excavation is barricaded?

  • Spoil pile is 2' away from edge?

  • Exit for employees - ramp or ladder within 25'?

  • Underground locate performed prior to digging?

  • Equipment parked min. 20' from excavation?

  • ELECTRICUTION

  • GENERAL ELECTRICAL HAZARDS

  • Temp. Electrical has GFCI, proper installation?

  • Cords not in doors or blocking access?

  • Cords are free from damage?

  • Lock out/tag out procedures in place?

  • Terminal boxes equipped with covers

  • Power lines at a safe distance (20+ feet)?

  • STRUCK BY

  • EQUIPMENT SAFETY

  • Lights, brakes, horn, and back up alarm operative?

  • Inspection and maintenance logs current?

  • Fire extinguisher installed?

  • Seat belts being worn?

  • Safe speeds, controlled motion?

  • Employees wearing vests?

  • Rigging inspected, safely configured, tagged?

  • CRANES

  • Outriggers fully extended; proper cribbing?

  • Power lines at a safe distance (20+ feet)?

  • Inspection and maintenance logs current?

  • Signalmen? Proper hand/verbal signals being used?

  • Load charts posted in the cab?

  • Operator trained?

  • Fire extinguisher installed?

  • FLAGGING

  • Trained flaggers utilizing proper signage and PPE?

  • STEEL ERECTION

  • Erection floor solidly planked or decked?

  • Other trades protected from overhead hazards?

  • Tag lines being used?

  • Rigging inspected, safely configured, and tagged?

  • Employees using fall protection? Secondary fall protection as needed?

  • CONCRETE AND MASONRY

  • Vertically protruding rebar capped?

  • Forms properly installed and braced?

  • Route planned for concrete trucks?

  • Silica controls - water, vacuum tools, etc. (No dry cutting of concrete allowed)

  • Masonry walls over 8' adequately braced?

  • Eye protection (Glasses and face shield) gloves and boots when cutting and/or grinding?

  • OTHER HAZARDS

  • CONFINED SPACE

  • Manhole air quality is tested before entry?

  • Manholes are ventilated/blowers used before and during work, especially in shot rock areas?

  • Purge with air at least 5 minutes before entry?

  • No employees in manhole during stack out?

  • PROTECTION OF THE PUBLIC

  • Roads, sidewalk, public access areas safe?

  • HOUSEKEEPING

  • Jobsite entrances are clean and in good order?

  • OTHER

  • SDS book is on site?

  • Jobsite required posters?

  • First-aid kit is stocked, nearest clinic identified?

  • Emergency action plan shared?

  • Fire extinguishers are onsite? (One for every 3,000 SF min.)

  • Drinking water is available?

  • Toilets are maintained?

  • Fuel storage bermed/protected; 20lb fire extinguisher between 25'-75' (min./max)

  • PM Signature

  • Superintendent Signature

  • Foreman Signature

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.