Safety Self Assessment

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Housekeeping

• Are project work areas clean and free of excess trash and debris?

  Yes

  No

  N/A

• Are walkways and passageways clear?<br>

  Yes

  No

  N/A

• Are equipment and material properly stored?

  Yes

  No

  N/A

• Are all cords, hoses or welding leads placed to prevent trip hazards?

  Yes

  No

  N/A

• Are scrap materials free of protruding nails or other puncture hazards?

  Yes

  No

  N/A

• Are trash cans provided where needed?

  Yes

  No

  N/A

• Are barricades and or rebar caps installed and maintained?

  Yes

  No

  N/A

• Is MSDS book available and current?

  Yes

  No

  N/A

Personal Protective Equipment

• Are hard hats worn and maintained properly?

  Yes

  No

  N/A

• Is hearing protection provided and worn as required?

  Yes

  No

  N/A

• Is eye protection being worn in a proper manner?

  Yes

  No

  N/A

• Is proper foot wear being used for the job performed?

  Yes

  No

  N/A

• Are face shields and goggles being worn as required?

  Yes

  No

  N/A

• Is additional P.P.E. needed?

  Yes

  No

  N/A

Fall Protection

• Are harnesses being worn properly?

  Yes

  No

  N/A

• Are lanyards adequately secured to suitable anchorage?

  Yes

  No

  N/A

• Is adequate perimeter guarding in place?

  Yes

  No

  N/A

• Are static or rat lines installed and capable of supporting 5400 lbs of force?

  Yes

  No

  N/A

• Is fall protection only being used for fall protection?

  Yes

  No

  N/A

• Is all fall protection maintained and stored properly?

  Yes

  No

  N/A

• Are all inspections current?

  Yes

  No

  N/A

Misc.

• Are eating and drinking areas designated?

  Yes

  No

  N/A

• Are electrical panels and breakers labeled?

  Yes

  No

  N/A

• Has required daily documentation been completed?

  Yes

  No

  N/A

Scaffolding / Ladders

• Are all scaffolds built to specification?

  Yes

  No

  N/A

• Is proper access and egress provided?

  Yes

  No

  N/A

• Is Scaffolding tagged properly?

  Yes

  No

  N/A

• Is the proper ladder for the job being used?

  Yes

  No

  N/A

• Is ladder secured properly?

  Yes

  No

  N/A

• Is the ladder at a proper angle and does it exceed the landing 3 ft?

  Yes

  No

  N/A

Hoisting and Lifting equipment

• Are chainfalls, come-a-longs, and chokers in good condition?

  Yes

  No

  N/A

• Are softeners used as needed?

  Yes

  No

  N/A

• Are proper rigging technique used?

  Yes

  No

  N/A

• Is rigging inspection current?

  Yes

  No

  N/A

Vehicles / Mobile Equipment

• Is pre-shift inspection complete and accurate?

  Yes

  No

  N/A

• Are operators task trained for the equipment being operated?

  Yes

  No

  N/A

Tools and Equipment

• Are electrical cords in good condition with current inspection?

  Yes

  No

  N/A

• Are tools maintained in a safe condition?

  Yes

  No

  N/A

• Are tools carried and stored properly?

  Yes

  No

  N/A

• Are pneumatic/ hydraulic hoses properly connected and secured?

  Yes

  No

  N/A

• Is the proper tool being used for the job?

  Yes

  No

  N/A

• Is bench-mounted equipment adjusted properly?

  Yes

  No

  N/A

Permits

Fire Protection

• Are flammables stored properly?

  Yes

  No

  N/A

• Are oxygen and combustibles separated properly?

  Yes

  No

  N/A

• Are containers labeled properly?

  Yes

  No

  N/A

• Are fire extinguishers properly located and inspected?

  Yes

  No

  N/A

• Are flash arresters installed?

  Yes

  No

  N/A

• Are compressed gas cylinders properly maintained?

  Yes

  No

  N/A

• Are containments and welding screens being used as required?

  Yes

  No

  N/A

• Are regulator gauges properly attached and maintained?

  Yes

  No

  N/A

• Are applicable permits posted?

  Yes

  No

  N/A

• Is the JSA completed and reviewed by the crew?

  Yes

  No

  N/A

• Are all specialized procedures being followed? ( haz-mat, confined space, lead, asbestos )

  Yes

  No

  N/A

• Select date

  Date

• Supervisor

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• Safety Rep.

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