Information
Information
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Inspector Name
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Position
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Site Visited
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Date
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Check Box if non-compliant
Personal Protective Equipment As Required
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Hard Hat
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Explain
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Safety Glasses and/or Face Shield
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Explain
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Hearing Protection
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Explain
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Respiratory Protection
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Explain
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Gloves
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Explain
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Boots for the Task
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Explain
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Chaps
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Explain
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Sleeved Shirt & Long Pants
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Explain
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High Visibility Shirt or Vest Worn
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Explain
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Safety Vest as Required (Reflective at Night)
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Explain
Equipment
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Equipment Inspected
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Explain
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Guarding of Machine Parts
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Explain
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Horns, Lights, Back-up Alarms & Cameras Working
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Explain
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Seat Belts Worn
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Explain
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Floorboard Free of Clutter
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Explain
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Steps Clear of Debris
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Explain
Work Site
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Organized Flow
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Explain
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Standard Railing & Toe Boards Installed
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Explain
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Berms or Guard Rails in Place
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Explain
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Electrical Hazards
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Explain
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Fire Extinguishers Mounted, Available, Inspected
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Explain
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Eye Wash Stations Inspected and Clear
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Explain
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Flammable Liquids & Gasses Controlled
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Explain
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JHAs Available
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Explain
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MSDS Available
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Explain
Personal Risk Management
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Working Responding to Hazards
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Explain
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Proper Lifting
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Worker Trained for Task
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Explain
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Works Protected from Fall Above 10 Feet
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Explain
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Repetitive Motion Hazards
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Explain
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Explain
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Extreme Heat/Cold - Hydration and Breaks
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Explain
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Drug and Alcohol Free
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Explain
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Workers Protected from Open Sides 4 Feet or Greater Above Lower Surface
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Explain
Trenching Site
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4' or 5' Deep - Egress (ladder) Within 25'
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Explain
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5' or Deeper - Properly Sloped or Shored/Shielding & Ladder within 25'
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Explain
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Standing or Flowing Water Controlled
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Explain
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Spoil Pile Minimum of 2' Away from Trench Edge
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Explain
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Soil Classified - Visual and Manual
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Explain
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Trenching Data Available
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Explain
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Utilities Marked - Uncovered Utilities Supported
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Explain
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Workers not Exposed to Cave-in or Falling Object
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Explain
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Competent Authroity Near By
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Explain
Housekeeping
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Egress Clear
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Explain
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Slip or Trip Hazard
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Clutter
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Explain
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Explain
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Food not Consumed in Industrial Maintainence
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Explain
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Vegetation Controlled
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Explain
Employee Interview Good attitude employees had safety meeting
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Safety Statement?
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Explain
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Toolbox Talk Understood?
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Explain
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Supervisory Support of Safety?
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Explain
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Unchecked Hazards?
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Explain
Reinforcement of Safety Culture
Reinforcement of Safety Culture
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No Findings.
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Explain
- Safe and Healthful Work Site - Employee Recognized for Support of Safety
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Audit Positive Comments:
- Unsafe Task Observed - Corrective Action Taken
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Audit Corrective Comments
Driver Observations
Driver Observations
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Driver or Unit #
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Driver is Properly Wearing Seat Belt
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No Evidence Driver is Using Handheld Cell Phone
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No Evidence Driver is Distracted by Map, Food, GPS, etc.
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Comments:
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Driver or Unit #
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Driver is Properly Wearing Seat Belt
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No Evidence Driver is Using Handheld Cell Phone
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No Evidence Driver is Distracted by Map, Food, GPS, etc.
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Comments:
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Driver or Unit #
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Driver is Properly Wearing Seat Belt
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No Evidence Driver is Using Hand Held Cell Phone
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No Evidence Driver is Distracted by Map, Food, GPS, etc.
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Comments:
