Title Page
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Supervision
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FALL HAZARDS
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GENERAL FALLS
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Floor openings covered/guard rails in place?
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Roof edge adequately guarded?
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All horizontal lifelines engineered?
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Leading edge protection and signage in place?
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PFA's worn properly, 100% protection, inspected?
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Employee's protected from fall exposures 6+ feet?
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LADDERS
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Secured at top and bottom?
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Extended 36" above landing?
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Rails and rungs in good repair?
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Step ladder in good repair, used properly?
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STAIRS
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Stairways clear from tripping hazards?
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Metal pans poured, filled, or barricaded from use?
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Handrails installed on stairways and landings?
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SCAFFOLDING
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Scaffolding inspected?
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Scaffolding plumb?
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Scaffolding tied at 4x the base dimension?
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Mud sills provided?
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Guard rails, mid-rails, toe boards, and feet installed?
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Fully planked?
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Power lines inactive, removed or at a safe distance (20' from scaffold)
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AERIAL LIFTS/MAN LIFTS
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Tied off in articulating boom lift?
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Chain closed on scissor lift?
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Training verified? Being operated safely?
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Power lines safe or at a safe distance (20+ feet)?
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Protection from drop offs and holes?
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CAUGHT IN-BETWEEN
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EXCAVATIONS
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Written daily inspections done by Competent Person?
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Shored, sloped, or benched 1.5:1 unless can prove better soil type?
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Tabulated data on site?
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Slope toe is 18" below trench box?
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Trench box max 2, above bottom of trench?
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Trench boxes not damaged or missing parts?
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Excavation is barricaded?
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Spoil pile is 2' away from edge?
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Exit for employees - ramp or ladder within 25'?
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Underground locate performed prior to digging?
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Equipment parked min. 20' from excavation?
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ELECTRICUTION
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GENERAL ELECTRICAL HAZARDS
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Temp. Electrical has GFCI, proper installation?
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Cords not in doors or blocking access?
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Cords are free from damage?
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Lock out/tag out procedures in place?
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Terminal boxes equipped with covers
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Power lines at a safe distance (20+ feet)?
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STRUCK BY
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EQUIPMENT SAFETY
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Lights, brakes, horn, and back up alarm operative?
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Inspection and maintenance logs current?
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Fire extinguisher installed?
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Seat belts being worn?
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Safe speeds, controlled motion?
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Employees wearing vests?
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Rigging inspected, safely configured, tagged?
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CRANES
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Outriggers fully extended; proper cribbing?
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Power lines at a safe distance (20+ feet)?
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Inspection and maintenance logs current?
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Signalmen? Proper hand/verbal signals being used?
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Load charts posted in the cab?
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Operator trained?
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Fire extinguisher installed?
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FLAGGING
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Trained flaggers utilizing proper signage and PPE?
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STEEL ERECTION
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Erection floor solidly planked or decked?
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Other trades protected from overhead hazards?
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Tag lines being used?
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Rigging inspected, safely configured, and tagged?
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Employees using fall protection? Secondary fall protection as needed?
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CONCRETE AND MASONRY
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Vertically protruding rebar capped?
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Forms properly installed and braced?
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Route planned for concrete trucks?
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Silica controls - water, vacuum tools, etc. (No dry cutting of concrete allowed)
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Masonry walls over 8' adequately braced?
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Eye protection (Glasses and face shield) gloves and boots when cutting and/or grinding?
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OTHER HAZARDS
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CONFINED SPACE
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Manhole air quality is tested before entry?
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Manholes are ventilated/blowers used before and during work, especially in shot rock areas?
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Purge with air at least 5 minutes before entry?
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No employees in manhole during stack out?
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PROTECTION OF THE PUBLIC
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Roads, sidewalk, public access areas safe?
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HOUSEKEEPING
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Jobsite entrances are clean and in good order?
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OTHER
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SDS book is on site?
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Jobsite required posters?
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First-aid kit is stocked, nearest clinic identified?
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Emergency action plan shared?
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Fire extinguishers are onsite? (One for every 3,000 SF min.)
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Drinking water is available?
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Toilets are maintained?
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Fuel storage bermed/protected; 20lb fire extinguisher between 25'-75' (min./max)
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PM Signature
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Superintendent Signature
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Foreman Signature