Safety Inspection

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Administration

• Supervisor Safety Inspections<br>

  Yes

  No

  N/A

• MSDS Available

  Yes

  No

  N/A

• Emergency plan and phone numbers posted

  Yes

  No

  N/A

• State / fed posters

  Yes

  No

  N/A

• PPE Available and inspected

  Yes

  No

  N/A

• Electrical safe work procedures enacted. Qualified person

  Yes

  No

  N/A

Electrical hazards

• Adequate lighting for working conditions

  Safe

  At Risk

  N/A

• Cords in good condition and protected from traffic

  Safe

  At Risk

  N/A

• Electrical panels protected from unqualified persons

  Safe

  At Risk

  N/A

• GFCI functioning properly

  Safe

  At Risk

  N/A

• LOTO procedures in place and enforced

  Safe

  At Risk

  N/A

• Proper use of temporary electrical panel /signage present / locked

  Safe

  At Risk

  N/A

• Testers being used inspected

  Safe

  At Risk

  N/A

• Hot work not being performed

  Safe

  At Risk

  N/A

• Safety plates on outlets and j boxes

  Safe

  At Risk

  N/A

• J-box knockouts covered

  Safe

  At Risk

  N/A

Excavations

• Surface traffic exposure

  Safe

  At Risk

  N/A

• Access with in 25 feet

  Yes

  No

  N/A

• Excavation permit filled out/ competent person present

  Yes

  No

  N/A

• Perimeter protected/ barricated

  Yes

  No

  N/A

• Sloped or shored

  Yes

  No

  N/A

• Spoil 2 ' from the edge

  Yes

  No

  N/A

• Surface conditions safe/ water, fissures

  Yes

  No

  N/A

• Employees trained

  Yes

  No

  N/A

Fall Protection

• Anchor point above shoulder

  Safe

  At Risk

  N/A

• Elevated work protected from possible fall hazards

  Safe

  At Risk

  N/A

• Fall protection plan in place (site specific)

  Safe

  At Risk

  N/A

• Brief sketch of fall protection plan

  Drawing

• Select date

  Date

• Employees Trained

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Fall protection method

• Fall Protection Methods

  Select Standard guardrails fall arrest system fall restrained system warning line system safety monitored system other fall protection system

  • Standard guardrails
  • fall arrest system
  • fall restrained system
  • warning line system
  • safety monitored system
  • other fall protection system

• Horizontal Life Line inspected, used properly, employees trained

  Safe

  At Risk

  N/A

• Vertical Life Line inspected employees trained

  Safe

  At Risk

  N/A

• Floor / wall / window openings protected

  Safe

  At Risk

  N/A

• Overhead protection in place

  Safe

  At Risk

  N/A

• Proper anchorage points

  Safe

  At Risk

  N/A

• Harness worn properly

  Safe

  At Risk

  N/A

• Retractable inspected

  Safe

  At Risk

  N/A

Housekeeping

• Clear access to work area and equipment

  Safe

  At Risk

  N/A

• Access elevations greater than 19'' eliminated

  Safe

  At Risk

  N/A

• Work area and equipment clear of debris and materials

  Safe

  At Risk

  N/A

• Proper material storage and trash receptacles

  Safe

  At Risk

  N/A

• Slip trip hazards eliminated

  Safe

  At Risk

  N/A

• Toilets clean

  Safe

  At Risk

  N/A

Ladders

• Extension ladders used to gain access only

  Safe

  At Risk

  N/A

• Inspected for defects

  Safe

  At Risk

  N/A

• Ladders used for intended purposes only

  Safe

  At Risk

  N/A

• Safe procedures followed

  Safe

  At Risk

  N/A

• Safe work distance from hazards

  Safe

  At Risk

  N/A

• Yes

  No

  N/A

Equipment

• Operator trained on that particular equipment/training log on file

  Safe

  At Risk

  N/A

• Equipment inspections and workplace inspections performed

  Safe

  At Risk

  N/A

• Material loaded properly and with in equipment specified capacity

  Yes

  No

  N/A

• Operating on flat surface /scissor lifts and boom lifts

  Safe

  At Risk

  N/A

• Safety equipment and procedures utilized

  Safe

  At Risk

  N/A

• Safe work distance from elevation changes

  Safe

  At Risk

  N/A

Personal Protective Equipment

• Safety glasses being used / side shields

  Safe

  At Risk

  N/A

• All required PPE being used

  Safe

  At Risk

  N/A

Scaffolds

• Check list filled out and approved by competent person

  Yes

  No

  N/A

• Green tag in place

  Yes

  No

  N/A

• Are there any deficiencies

  Yes

  No

  N/A

Results

• How are deficiencies to be corrected

• Supervisor on site

  Sign

• Auditor's Signature

  Sign