Safety Inspection - Short

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Fire extinguisher

• First Aid Kit

• SDS Binder

• Tab Data Binder

PPE

• Are hardhats being worn when working near moving equipment or underneath suspended loads?

  Yes

  No

  N/A

• Insert the name of the employee not wearing a hardhat and correct the issue

• Are all workers wearing ANSI approved safety glasses?

  Yes

  No

• Insert the name of the employee in violation of the safety glasses policy and correct the issue

• Is a class 2 safety vest being warn by all employees working within 25' of a roadway?

  Yes

  No

  N/A

• Insert the names of employee(s) not wearing class 2 reflective clothing when required and correct the issue

• Are multi purpose saws or chainsaws in use?

  In use

  Not in use

• Are employees wearing proper face shields?

  Yes

  No

• Insert the name of the worker not using the proper face shield and correct the issue

• Are ear plugs being worn when necessary?

  Yes

  No

• Problems, Concerns, or Comments:

• Please add any photographs that are relevant to the PPE category

  Media

Trenching/Excavation

• List the competent person:

• List the soil type:

• Is there some form of trench protection in place (Sloping, Benching, Shielding, Shoring)?

  Yes

  No

  Not over 5' deep, trench is safe

• Employees must exit the trench/excavation until appropriate protective measure is establishes

• List the protective measure used on the trench/excavation:

  Sloping

  Benching

  Shielding

  Shoring

  Under 5' deep and safe, N/A

• Is the trench protection method being used correctly for the soil type being excavated?

  Yes

  No

• Evacuate the trench/excavation until proper protective measure is established

• Is there access/egress within 25 lateral feet of each employee in the trench/excavation (if over 4 feet)?

  Safe

  At Risk

• Establish appropriate access/egress

• Photograph the means of access/egress

  Media

• Are excavation logs being filled out daily?

  Yes

  No

• Correct this issue with the foreman/competent person

Site Organization

• Are roadways being kept clean of rocks, mud, and debris on a regular basis?

  Yes

  No

• Instruct foreman/competent person to address this issue

• Are materials being stored in an organized manner?

  Yes

  No

• Photograph organized materials

  Media

• Recommend a more efficient way or material storage

• Are all material being stored at least 2' from the edge of the trench?

  Yes

  No

• Photograph the spoils pile

  Media

• Fix the issue on the spot

Equipment

• Do back up alarms work on all pieces of equipment?

  Yes

  No

• Coordinate the repair with Nick Collins immediately

• Are fire extinguishers charged and mounted on each piece of equipment?

  Yes

  No

• Remove the loose extinguisher from the vehicle/equipment until a repair can be coordinated with Nick Collins

• Are equipment seat belts functional and in use?

  Yes

  No

  No Equipment in Use, N/A

• Perform proper lockout/tag out procedures and don't use vehicle/equipment until the seat belt is functional. If seat belts aren't being worn, correct this issue on the spot

• Are equipment windows clean, free of cracks, and clear?

  Yes

  No

• Fix the issue prior to continuing use of the vehicle/equipment

• Equipment number and hours of machinery on site:

• Problems, Concerns, or Comments:

• Add any relevant photos regarding the equipment inspected:

  Media

• Please add any hazards that are observed on this job-site visit. Also indicate the solution to fix these hazards (whether through use of engineering controls, administrative controls, or PPE).