Information
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
1. Working at Heights
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1.1. Fall arrest/protection system used properly (including aerial lifts)?
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1.2. Protection from openings/edges/holes?
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1.3. Guardrail systems correct?
2. Scaffolds
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2.1. Competent persons erecting scaffold?
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2.2. Safe and complete scaffold?
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2.3. Proper inspection protocol for scaffold?
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2.4. Compatible scaffold components?
3. Material Handling Equipment
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3.1. Loads are not lifted over persons, close proximity to obstacles incl. overhead power lines?
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3.2. Proper maintenance, testing and inspection?
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3.3. Operators manual, lifting charts, informational decals available/legible?
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3.4. Daily inspection?
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3.5. Appropriate and undamaged lifting equipment, including ropes, slings, chains, hooks?
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3.6. Qualified/certified operators?
4. Ladders
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4.1. Appropriate and undamaged ladders?
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4.2. Correct positioning/set-up of ladders?
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4.3. Ladder properly secured?
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4.4. Ladder suitable for job? (e.g. metal ladder used for electrical work, use)
5. Hazardous Chemical (including fuel and oil)
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5.1. Safe storage location? (e.g. flammables near ignition sources, spills could enter stormwater drains, etc)
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5.2. Incompatible chemicals stored properly?
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5.3. Adequate spill containment equipment?
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5.4. Emergency procedures for injury/spills/fire etc?
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5.5. Appropriate quantities stored on site or in vehicles?
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5.6. Sufficient ventilation?
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5.7. Suitable storage containers?
6. Traffic Management
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6.1. Adequate Traffic Management Plan (TMP) in place?
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6.2. Adequate controls for TMP? (physical barriers, bollards, speed limits, flashing lights, spotters, etc)
7. Personal Protective Equipment (PPE)
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7.1. Proper Use and selection of PPE?
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7.2. Issue, inspect, replace and monitor PPE?
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7.3. Training in proper use, maintenance and inspection of PPE?
8. Work Environment
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8.1. Sufficient lighting?
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8.2. Adequate housekeeping (slip, trip, fall hazards, etc.)
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8.3. Adequate noise/ vibration control?
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8.4. Exits marked and unobstructed?
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8.5. Impalement hazards protected?
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8.6. Permit Required Confined Space (IAW permit, trained personnel, etc)?
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8.7. Fire extinguishers inspected, unobstructed and available (travel distance)?
9. Electrical Hazards
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9.1. Safe electrical conductor? (damaged, out of test date or untested)
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9.2. All outlets/tools GFCI?
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9.3. Maintain clearance with overhead electrical/power lines?
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9.4. No overloaded outlets?
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9.5. Temporary lights elevated & lamps caged?
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9.6. Energized work plan/permit used? (Competent Person)
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9.7. Openings in cabinets or boxes covered?
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9.8. Panels covered, locked and labeled?
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9.9. Conductors secured properly?
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9.10. Temporary splices covered?
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9.11. Lack of Lock-out/tag-out (LOTO) procedures followed?
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9.12. Appropriate ARC-Flash PPE?
10. Environmental Hazards
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10.1. Clear and/or controlled rodents, insects, snakes, wild/domestic animals?
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10.2. Adequate dust suppression control?
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10.3. Adequate systems to prevent contaminants entering stormwater drains?
11. Administrative Procedures
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11.1. Adequate Pre-Task Plan?
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11.2. Obtain applicable permits (Entry, Hot, etc.)
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11.3. Site Emergency Action Plan?
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11.4. Toolbox Talks?
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11.5. Competent, qualified, licensed personnel?
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11.5.1. 1st Aid/CPR, aerial/scissor lifts, confined space, powder actuated tools, mobile equipment
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11.6. Corporate Safety Manual?
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11.7. Safety Data Sheets readily available, on site?
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11.8. State/Federal Postings?
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11.9. First Aid Kit/Eyewash?
Corrective Actions
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Enter any corrective actions that will be undertaken
Sign Off
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On site representative
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Auditor's signature
