Safety report

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Is JHA completed by operator / crew leader

• Question

  Yes

  No

  N/A

• Select date

  Date

Truck inspected (truck clean, organized)

• Question

  Yes

  No

  N/A

• Add media

  Media

Drinking water

• Yes

  No

  N/A

First Aid Kit

• Question

  Yes

  No

  N/A

House Keeping (trailer, work area,truck)

• Question

  Yes

  No

  N/A

• Add media

  Media

Is personal protective equipment properly worn

• Question

  Yes

  No

  N/A

• Add media

  Media

Walking/working surfaces ( tripping hazards, slippery surfaces, floor holes)

• Safe

  At Risk

  N/A

• Add media

  Media

• Add drawing

  Drawing

Fall Protection

• Safe

  At Risk

  N/A

• Add media

  Media

Electrical tools and cords

• Safe

  At Risk

  N/A

• Add media

  Media

Fire extinguisher inspected and accessible

• Yes

  No

  N/A

Equipment inspected ( skid steer, sky trac, forklift, backhoe, floor machine, mini excavator )

• Yes

  No

  N/A

Boom lift or scissor lift inspected

• Yes

  No

  N/A

Harness and lanyard properly worn

• Yes

  No

  N/A

Ladder safety

• Safe

  At Risk

  N/A

• Add media

  Media

Excavation Properly slope,shore,inspected

• Safe

  At Risk

  N/A

• Add media

  Media

Scaffold inspected (fully planked,guard rails, secure)

• Safe

  At Risk

  N/A

• Add media

  Media

Traffic control

• Safe

  At Risk

  N/A

Additional observations and recommendations

• Safe

  At Risk

  N/A

• Add media

  Media

Signature

• Add signature

  Sign