Title Page

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • Select date

  • Jobsite

  • Supervisor

  • Overview job pictures

  • Performance rating:10 being the best( little to no risk), and 1 being worst( high risk for injuries or fines)

  • General audit comments

Explanation of audit scoring

  • "Yes" ( green color) 2 points
    ( the job site performance met or exceeded expectations for this specific audit question)
    " improve"( yellow color) 1 point
    ( the performance generally met expectations, but some specific improvements are needed.)
    " no" (red color) 0 points
    ( The performance failed to meet expectations, or serious violations.)
    "N/A" ( blue color)
    (If a question does not apply to the job site activities, the auditor will select N/A for "not applicable ", and no score will be added or
    Subtracted from the audit.

P.P.E

  • Are employees wearing hard hats 100% of the time?

  • Are safety glasses worn 100% of the time?

  • Are employees wearing appropriate safety glasses for their environment? ( no sunglasses in dark areas ,no fogging,no defects)?

  • Are face shields in use when needed?

  • Are employees wet cutting?

  • Are employees wearing high visibility clothing?

  • Are employees wearing work boots that comply with OSHA and Rabon requirements?

HazCom

  • Containers labeled properly?

Fall protection

  • Is the fall arrest equipment in good working order( fully functional,no defects,or damage)?

  • Are harnesses worn correctly, with appropriate connection devices (lanyards,SRL) attached to adequate anchorage points ( able to withstand 5,000 lbs force or an engineered safety factor of two times the potential force of the fall)?

  • Have all affected employees been trained on the proper use of personal fall protection systems?

  • Are all employees ( with in 15' of leading edge) protected by personal fall arrest system or guard rail systems?

Scaffolds

  • Are scaffolds built level and plumb?

  • Are mud sills (pads) in place, level, and are put on stable ground?

  • Are screw jacks in place,center on pad, and are not jacked up to high?

  • Have all braces been put in place?

  • Are scaffolds fully planked ( where employees are working)?

  • Do plank extend 6" but not more than 12" over frames?

  • Are all guard rails, and end rails in place (6' tall or higher) if employees are working from or accessing the jump?

  • Have all toe boards been installed on all decks with material on them?

  • When foot plank is being used are their foot plank end rails in place (over 6 feet)?

  • Have bricklayer access been put in place when needed?

  • Are scaffolds erected no higher than three times the minimum base width without being tied off to the structure?

  • Are the levels the employees are working on free of debris, and can be Easley walk-through?

  • Have employees made safe access to the tiers they are working on( ladders,Hewitt Systems,ect.)

  • Have scaffold tags been filled out( signed and dated) ?

Fire protection

  • Are all flammable safety cans properly labeled?

  • Are all fire extinguishers posted near all flammable storage areas and hot work zones?

  • Do all fire extinguishers have a tag demonstrating they have received documented annual inspection?

  • Are all fire extinguishers in good working order (pin and tamper seal present ,good pressure,and hose free ofunobstructed?

Power machinery

  • Are all documented inspections completed daily?

  • Are all pieces of powered equipment operating well without leaks or obvious signs of physical defects?

  • Are all attachments secured from movement?

  • Are all equipment operators trained and certified on the equipment they are running( forklifts,skid loader, Cranes,ect.)?

Electrical equipment (power tools)

  • Are all extension cords in good condition?

  • Are all manufacturer recommended guards properly mounted and used?

  • Are extension cords plugged in to GFCI protected outlets?

Winter enclosures

  • Has the scaffold been secured to the structure or tied down with cables at 15' horizontally and 13' vertically ?

  • Are approved heaters being used?

  • Are heaters being properly ventilated in the shelter?

  • Are there fire extinguishers located close to the heaters?

House keeping

  • Is equipment being cleaned ( mixers, tubs,shovels,ect.)?

  • Are materials being stored properly ?

  • Has used material and debris been cleaned up?

Hydro Mobile

  • Are Hydro Mobiles built/set level and plumb?

  • Are the Hydro Mobiles in good working order? No leaks, broken or damaged parts, etc?

  • Are proper access points in place?

  • Are guard rails and barriers in place to protect employees from fall hazards?

  • Are the legs and braces deployed and on a stable/appropriate mudsill?

  • Are employees aware of weight limits when using the hydromobile systems?

  • Has weight been distributed evenly to avoid tipping or over balancing?

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.