Information
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(Revision 06-2013)
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Name and Address of Project
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Name of Team Leader
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# of Employees
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Date Audit Performed
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Prepared by
1.0 Fall Protection (Warning Line)
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1.1 Line 34-39 inches above working surface.
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1.2 Flagging every six (6) feet.
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1.3 Stands can Withstand 16 lbs. of Tipping Force.
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1.4 Rope is Stronger than 500 lbs. Tensile Strength.
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1.5 Warning Line 6 - 10 Feet Away from Fall Hazards.
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1.6 Fall Arrest, Fall Restraint, or Safety Monitor Used for Work Outside Warning Line.
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2.0 Fixed Stairs
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2.1 Fixed Stairs
3.0 Fixed Ladder
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3.1 Fixed Ladder
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3.2 Secured to Wall or Structure
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3.3 Safe to Climb
4.0 Extension Ladder
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4.1 Extension Ladder Used
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4.2 Has inspection tag.
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4.3 Missing, bent, or broken parts
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4.4 Missing fly rope.
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4.5 3 ft. above landing or eave.
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4.6 Secured at top.
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4.7 Secured at bottom.
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5.0 PPE
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5.1 Hearing Protection Required for Loud Noises.
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5.2 Hard Hat worn for overhead hazards and work.
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5.3 Longs Pants Required for Hot Work
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5.4 Long Sleeved Shirt Required for Hot Work
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5.5 Respirator Required.
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5.6 Safety Glasses
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5.7 Worn for tear off.
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5.8 Worn for other eye hazards.
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5.9 PPE worn correctly.
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6.0 Electrical
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6.1 Electrical Used.
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6.2 Wires inspected.
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6.3 GFCI Used for Temporary Power Sources.
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6.4 Work Remains 20 feet Away from Electrical Lines
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6.5 Covers Required for Electrical Lines.
7.0 Material Hoisting
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7.1 Trash Chute or Hoisting Used for Elevated Projects (20 feet or more)
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7.2 Pallets Not Stacked More than 2 High
8.0 Cranes
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8.1 Crane Used.
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8.2 Crane Operator Trained.
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8.3 Signal Person Trained and Communicates with Operator.
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8.4 Sling tag available and serviceable for use.
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8.5 Overhead Work Signs Posted near Hoisting Area(s).
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8.6 Flagging or Warning Lines Around Crane and Lift Area.
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8.7 Taglines Used for Material or Equipment Control.
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9.0 Fire Prevention
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9.1 Extinguishers within 25 - 50 feet of Work.
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9.2 Used / Spent Extinguishers removed from Project or Site.
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9.3 Gas Cans Labeled and Stored.
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9.4 Screen Located Within Gas Cans.
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10.0 Forklift
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10.1 Forklift Used.
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10.2 Forklift Operator Trained.
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10.3 Daily Inspection Performed.
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10.4 Rigger Trained and Communicates with Operator.
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10.5 Signal Person Trained and Communicates with Operator.
11.0 General Liability
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11.1 Nails Bent or Removed from Boards.
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11.2 Roof Tie-in Performed Daily.
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11.3 Plugs Removed from Drains.
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11.4 Work logged Daily in a Journal.
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11.5 Site or Project Inspected for Previous Damage.
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11.6 Caution Signs Posted.
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12.0 Emergency Readiness
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12.1 First Aid Kit (with Eye Wash Bottle) On-Site and Available to Employees.
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12.2 HAZCOM Manual On-Site and Available to Employees.
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12.3 Safety Manual On-Site and Available to Employees.
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13.0 Scaffold.
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13.1 Scaffold Required
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13.2 Scaffold has Hoist for Materials.
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13.3 Access Secured at Night.
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13.4 Inspected by Competent Person.
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13.5 Scaffold has Green Tag for Use.
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13.6 Scaffold is level.
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13.7 4:1 Ratio and Tied to Building (Push / Pull)
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13.8 Walk Boards Bent.
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14.0 Safety Talks
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14.1 Performed Weekly, Signed & Turned In