Information

  • Audit Title

  • Document No.

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

1. Housekeeping/Material Storage/Chemical Storage/Sanitation

  • 1.1. Chemical/Fuel Storage (Gasoline, Diesel, Combustibles stored in metal safety cans or other authorized storage). Oxygen/Acetylene Properly Stored (Upright and Secured, 20 Feet Apart or Non-Combustible 30 Minute Fire Barrier)

  • 1.2 Access Passageways/Ladder Landings Clear of Debris, Walkways/Work Areas Clear of Debris

  • 1.3 Scrap Materials Free of Nails/Hazardous Protrusions or Properly Stockpiled/Barricaded/Caution Taped, Loose/Light Material Secured Against Displacement/Overhead Locations

  • 1.4 Lumber/Pipe/Materials Properly Stored/Secured Against Displacement

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

  • 1.6 Wash Station Available for Each Toilet Facility (Wash Station Located Outside or Separate From Toilet Facility)

2. Personal Protective Equipment

  • 2.1. All Employees Wearing Proper Protective Eye Wear For Task Performed (Safety Eye Wear Required)

  • 2.2. All Employees Wearing Approved Head Protection

  • 2.3. All Employees Wearing Minimum Class II High Visibility Clothing (Or Site Specific High Visibility Clothing)

  • 2.4. All Employees Wearing Hearing Protection (as Required)

  • 2.5. All Employees Wearing Appropriate Foot Wear (Steel Toe/Metatarsal Guard For Impact/Compaction Equipment)

  • 2.6. All Employees Wearing Appropriate Hand Protection For Assigned Task

  • 2.7. Employees Wearing Appropriate Respiratory Protection (If Required)

  • 2.8. First Aid Kit Stocked and Available

  • 2.9. Water, Shade Available As Required (1Quart Per Person Per Hour, Shade to Accommodate 1/4 Of Crew At Any Time)

3. Excavations

  • 3.1. RGW Pothole Protocol Utilized Prior To Opening New Excavation

  • 3.2. Excavations/Trenches Properly Sloped/Benched/Shored, Trenches/Excavations/Boxes/Shores Inspected By Competent Person Prior To Entry By Personnel

  • 3.3 Excavations Over 20' Designed and Stamped by Registered Engineer

  • 3.4 Ladder Access Within 25' of Employees in Trenches/Excavations Over 4' Deep

  • 3.5 Trenches/Excavations Properly Barricaded (As Needed/Required), All Pits/Shafts/Manholes etc. Properly Covered As Needed/Required

  • 3.6 Spoils/Tools/Equipment Properly Placed, Not Less Than 2' From Top Edge of Excavation

  • 3.7 Air Sampling Performed In All Trenches Greater Than 4' Deep, Where Hazardous Atmospheres May Exist (Landfills, Waste Treatment, etc.)

  • 3.8 Above Ground/Sub-Surface Installations Protected, Supported or Removed

4. Fall Protection/Retrieval Systems/Standard Guardrails

  • 4.1. Full Body Harnesses/Lanyards/Devices In Serviceable Condition

  • 4.2. Proper Anchor Points Provided/In Use (Support 5000 lbs. per person attached w/lanyard, Support 3000 lbs. per person attached with retractable lifeline)

  • 4.3. Retrieval Systems in Serviceable Condition (Tripod, Winches, Retractables, Related Hardware)

  • 4.4. Standard Guardrails Installed At All Walking/Working Locations Over 6' High (Or Protected By Appropriate Fall Protection Devices)

  • 4.5. Upright Post, Top and Mid Rails Properly Installed (Upright Spaced Not More Than 8' Apart, Top Rail Between 42"-45" from Floor, Mid Rail Half Way In Between)

  • 4.6. Toe Boards Properly Installed Over Walking/Working Areas Below Elevated Locations

5. Hoisting And Lifting Equipment

  • 5.1. Cranes/Boom Trucks, Documented Daily Inspection Complete Prior To Hoisting Operations

  • 5.2. Cranes/Boom Trucks Properly Set Up ( Outriggers/Mats/Swing Radius

  • 5.3. Rigging/Hardware In Serviceable Condition, Inspected By Competent Person

  • 5.4. All Rigging/Signaling Performed By Competent Person

  • 5.5. Power Lines Identified/Marked

  • 5.6. Tag Lines In Use Where Required

6. Material Handling Equipment/Powered Industrial Trucks

  • 6.1 Back Up Alarms Operational

  • 6.2 Seat Belts In Serviceable Condition

  • 6.3 Seat Belts In Use

  • 6.4 Buckets/Forks/Attachments/Connectors In Serviceable Condition (Attachment Pins, etc.)

  • 6.5 Equipment Operators Qualified/Certified

7. Tools and Equipment

  • 7.1. Hand Tools Maintained in Safe Condition (striking surfaces, handles, etc.)

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

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

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

  • 7.5. Powder Actuated Tools Maintained In Safe Condition (Guards, Handles, Loads Properly Stored)

  • 7.6. Specialty Tools Maintained In Safe Condition (Gas Operated Tools, Jacks, etc.

  • 7.7. Extension Cords Maintained In Safe Condition (Grounding Pins, Insulation, Protected Against Vehicular Traffic, etc.)

  • 7.8. Ground Fault Circuit Interruptors (GFCI) Operational

8. Welding/Cutting/Fire Protection

  • 8.1. Welding Leads, Torch Hoses Maintained In Safe Condition (Back Flow Preventers Installed On Torches)

  • 8.2. Combustibles/Flammables Stored Away From Hot Work

  • 8.3. Regulators, Gauges Properly Installed/Maintained

  • 8.4. Fire Extinguishers/Water Cans Located Near Hot Work

  • 8.5. Fire Extinguishers Have Current Inspection Tags (Must Have Up To Date Annual Inspection Sticker)

9. Confined Spaces

  • 9.1 Confined Spaces Identified/Marked

  • 9.2. Personnel Training Complete

  • 9.3. Air Sampling Complete, Engulfment Hazards Blocked Out

  • 9.4. Air Blowers Installed As Needed

  • 9.5. Entry Documentation Complete

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.