Information

  • Audit Title

  • Document No.

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Postings/Notices/Signage/Bulletins

  • 1.1 EEO, State/Federal Postings Visible To Employees,Medical Facilities Available And Posted, Emergency Action Plan, Medical Facilities Available And Posted

  • 1.2 IIPP On Site, Material Safety Data Sheets (MSDS) Available

  • 1.3 Office First-Aid Station Available/Stocked, Office Fire Extinguisher(s) Available and Up To Date

Housekeeping/Material Storage/Chemical Storage/Sanitation

  • 2.1 Chemical/Fuel Storage (Gasoline, Diesel, Combustibles stored in Metal Safety Cans), Oxygen/Acetylene Stored Properly (Upright and Secured/20 Feet apart or 30 minute Fire Barrier In Place<br>

  • 2.2 Lumber/Material Storage/Properly Stacked, Scrap Material Free Of Nails/Hazardous Protrusions Or Properly Stockpiled/Barricaded/Caution Taped

  • 2.3 Access Passageways/Ladders Clear Of Debris, Walkways/Work Areas Clear Of Debris

  • 2.4 Covered Trash Receptacles Available For General Debris/Non-Hazardous Material

  • 2.5 Loose/Light Material Secured Against Displacement From Wind/Unprotected Edges/Overhead Locations

  • 2.6 Appropriate Number of Toilets For Number Of Employees (1 per 20 Employees or Fraction Thereof of Each Sex)

  • 2.7 Wash Station Available For Each Toilet Facility (Wash Station Located Outside or Separate From Toilet Facility)

3. Ladders/Ramps/Work Area Access

  • 3.1 Job-Built Ladders Properly Constructed (15"-20" Wide Max. For Single Cleat, Rungs Not More Than 12" Top To Top)

  • 3.2 Ladders Properly Positioned/Secured At 4:1 Ratio (1` From Wall For Every 4` in Elevation), Ladder Extends Minimum 3` Above Landing

  • 3.3 Step Ladders Used Only with Legs Fully Extended (Not To Be Used As Single Ladder)

  • 3.4 Manufactured Ladders In Serviceable Condition Or Tagged And Removed From Service

  • 3.5 Ramps Properly Constructed/Maintained (Not Less Than 20" Wide, Supported To Avoid Springing Action)

  • 3.6 Securely Fastened Cleats For Ramps Sloped 2' in 10' Or More To Improve Footing

4. Personal Protective Equipment

  • 4.1 All Employees Wearing Proper Protective Eye Wear For Task Performed (Safety Eyewear Required)

  • 4.2 All Employees Wearing Hard Hats (Hard Hats Required)

  • 4.3 All Employees Wearing Minimum Class II High Visibility Clothing (Or Site Specific High Vis Clothing)

  • 4.4 Hearing Protection As Required

  • 4.5 Appropriate Footwear, Steel-Toe Shoe or Toe-Caps/Metatarsal Guards (When Using Impact Equipment i.e. Jackhammer, Compaction Equipment)

  • 4.6 Gloves/Appropriate Hand Protection For Assigned Task

  • 4.7 Proper Respiratory Protection As Required (Use, Care, Cleaning)

5. Fall Protection/Standard Guardrails

  • 5.1 Full Body Harnesses Properly Fitted/Lanyards/Positioning Devices (Use, Condition, Daily Inspection)

  • 5.2 Fall Protection Devices (Retractable Lifelines, Horizontal Lifelines, Connecting Devices) In Serviceable Condition

  • 5.3 Proper Anchor Points In Use (Support 5000 lb. Per Person Attached w/Lanyard, Support 3000 lb. For Retractable Lifeline)

  • 5.4 Proper Connecting Devices In Use/In Serviceable Condition (D-Rings, Straps, Concrete Anchors, Wood Anchors)

  • 5.5 Standard Guardrails Installed At All Walking/Working Locations Over 6` High

  • 5.6 Uprights, Top and Mid-Rails Properly Installed (Uprights Spaced 8' Max, Top Rail Between 42"-45" From Floor/Platform/Ramp, Mid-Rail Half Way In Between)

  • 5.7 Toe-Boards Properly Installed Over Walking/Working Areas Below Elevated Locations

6. Excavations

  • 6.1 RGW Pot-Hole Protocol Utilized Prior To Opening New Excavation

  • 6.2 Excavations Sloped/Benched/Shored Properly

  • 6.3 All Trenches, Boxes, Shields/Excavations Inspected/Documented By Competent Person Prior To Entry By Employees

  • 6.4 Excavations Over 20' Designed/Stamped By Registered Engineer

  • 6.5 Ladder Access Within 25' Of Employees In Trenches Over 4` Deep

  • 6.6 Trenches/Excavations/Shafts/Drill Holes/Pits Properly Barricaded/Covered/Protected As Needed

  • 6.7 Spoils/Tools/Equipment Properly Placed Not Less Than 2` From Top Edge Of Excavation

  • 6.8 Air Sampling Performed In All Excavations Greater Than 4` Deep Where Hazardous Atmospheres May Exist (Landfills, Waste Treatment Plants, Etc.)

  • 6.9 Above-Ground/Sub-Surface Installations Protected, Supported Or Removed

  • 6.10 Walkways/Bridges w/Standard Guardrails Installed Where Employees Must Cross Excavations Over 6` Deep and 30" Wide

7. Scaffolds

  • 7.1 Scaffold Systems Installed/Inspected by Competent Person

  • 7.2 Only Scaffold Grade Plank Utilized, Minimum 20" Walkway Provided,

  • 7.3 Standard Guardrails In Place, Walkway, Ladder or Other Safe Means Provided For Access To Scaffold

  • 7.4 Planks Shall Not Extend Less than 6" No More Than 18" Beyond Support Member

  • 7.5 Scaffold Ends Shut Off With Standard Guardrails (Unless Utilized For Proper Access)

8. Hoisting and Lifting Equipment

  • 8.1 Cranes/Boom Trucks Documented Daily Inspection Complete

  • 8.2 Cranes/Boom Trucks Properly Set Up (Outriggers, Crane Pads/Mats, Swing Radius)

  • 8.3 Rigging/Hardware Inspected By Competent Person

  • 8.4 All Rigging/Crane Signaling Performed By Qualified Riggers/Signal Persons

  • 8.5 Softeners Used As Needed For Sharp Edges

  • 8.6 All Rigging Properly Marked With Capacity Information, Etc., Rigging Not In Use Properly Stored, Unserviceable Rigging Tagged Or Destroyed<br>

  • 8.7 Overhead Power Lines Identified/Marked

  • 8.8 Tag Lines In Use Where Required

9. Material Handling Equipment/Powered Industrial Trucks

  • 9.1 Back-Up Alarms Operational

  • 9.2 Seat Belts In Serviceable Condition, Seat Belts In Use

  • 9.3 Bucket/Attachment Pins Attached/In Use

  • 9.4 Equipment Attachments In Serviceable Condition

  • 9.5 Equipment Operators Are Qualified/Certified

  • 9.6. Haul Roads Maintained, Properly Marked

10. Tools And Equipment

  • 10.1 Hand Tools Maintained In Safe Condition (Striking Surfaces, Handles, etc.)

  • 10.2 Power Tools Maintained In Safe Condition (Electrical Cord, Safety Guards, Handles, etc.)

  • 10.3 Pneumatic Tools Maintained In Safe Condition (Air Hose Connections, Safety Devices, etc.)

  • 10.4 Gas Powered Tools Maintained In Safe Condition (Guards, Handles, etc.)

  • 10.5 Powder Actuated Tools Maintained In Safe Condition (Guards, Handles, Loads Safely Stored)

  • 10.6 Gas Operated Tools Maintained In Safe Condition (Paslode Nail Gun)

  • 10.7 Specialty Tools (Falsework Jacks, Plates, etc.)

11. Electrical

  • 11.1 Extension Cords Maintained In Safe Condition (Grounding Pins, Insulation, etc.)

  • 11.2 Cords Protected Against Vehicular/Equipment Traffic

  • 11.3 Ground Fault Circuit Interruptors (GFCI) Working

  • 11.4 Junction Boxes Maintained In Safe Condition

12. Welding/Cutting/Fire Protection

  • 12.1 Welding Leads/Torch Hoses Maintained In Safe Condition, Back Flow Preventers Installed On Torch Setups

  • 12.2 Combustibles/Flammables Stored Away From Hot Work

  • 12.3 Regulators/Gauges Properly Installed/Maintained

  • 12.4 Fire Extinguishers/Water Cans Located Near Hot Work

  • 12.5 Fire Extinguishers Up To Date/Properly Maintained

13. Traffic Control

  • 13.1 Safe Pedestrian Access Provided

  • 13.2 Construction Area Signs Properly Maintained

  • 13.3 Temporary Traffic Control/Flaggers/Flagger Stations Properly Set Up/Maintained

  • 13.4 Safe Construction Area Access Provided

  • 13.5 Crash Cushions/Reflectors Properly Maintained

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.