Safety Survey

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Note: Make sure to label who the contractor was when applicable.

• Jobsite Postings (W-T Start Up Packet)

  Yes

  No

  N/A

• Safety Manuals (IIPP / LP / MSDS)

  Yes

  No

  N/A

• Safety Meetings (Conducted / Recorded)

  Yes

  No

  N/A

• Accident Report (Reported / Filed)

  Yes

  No

  N/A

• Safety Notices (Issued for Noncompliance)

  Yes

  No

  N/A

Personal Protective Equipment

• Hard Hats

  Yes

  No

  N/A

• Safety Glasses

  Yes

  No

  N/A

• Dust Mask - Ear Plugs

  Yes

  No

  N/A

Fire Extinguishers

• Accessible/3000 sq ft.

  Yes

  No

  N/A

• Charged

  Yes

  No

  N/A

• Inspected

  Yes

  No

  N/A

First Aid

• Accessible

  Yes

  No

  N/A

• Complete

  Yes

  No

  N/A

Flammable Liquids

• Approved Containers

  Yes

  No

  N/A

• Properly Stored

  Yes

  No

  N/A

• Labeled

  Yes

  No

  N/A

Grinders

• Guards in Place

  Yes

  No

  N/A

• Dust-masks Used

  Yes

  No

  N/A

• Eye Protection Used

  Yes

  No

  N/A

Welding Equipment

• Gauges/Hoses OK

  Yes

  No

  N/A

• Leads Good Condition

  Yes

  No

  N/A

• Proper Storage

  Yes

  No

  N/A

• Eye Protection

  Yes

  No

  N/A

Ladders

• Good Condition

  Yes

  No

  N/A

• Proper Height/Tied Off

  Yes

  No

  N/A

• Proper Type Available

  Yes

  No

  N/A

Power Tools

• Proper Guarding

  Yes

  No

  N/A

• Proper Working Order

  Yes

  No

  N/A

• Plug/Cord Good Cond

  Yes

  No

  N/A

Aerial Lifts

• Proper Use

  Yes

  No

  N/A

• Audible Alarm

  Yes

  No

  N/A

• Harness/Lanyard

  Yes

  No

  N/A

Excavations

• Competent Person

  Yes

  No

  N/A

• Proper Slope/Bench

  Yes

  No

  N/A

• Proper Spoil Pile

  Yes

  No

  N/A

• Ladder within 25'

  Yes

  No

  N/A

• Barricades in Place

  Yes

  No

  N/A

Impalement Hazards

• Rebar Capped

  Yes

  No

  N/A

• Other Projections Protected

  Yes

  No

  N/A

Fall Protection

• Guardrails in Place

  Yes

  No

  N/A

• Harness and Lanyards

  Yes

  No

  N/A

• Proper Barricades

  Yes

  No

  N/A

• Inspections Logged

  Yes

  No

  N/A

Floor Openings

• Covered & Secured

  Yes

  No

  N/A

• W-T Signage in Place

  Yes

  No

  N/A

• Inspections Logged

  Yes

  No

  N/A

Scaffolding

• Sub. Competent Person

  Yes

  No

  N/A

• Proper Use

  Yes

  No

  N/A

• Appears Complete

  Yes

  No

  N/A

Stairs

• Handrails in Place

  Yes

  No

  N/A

• Stair Treads Complete

  Yes

  No

  N/A

Electrical

• G.F.C.I. Available

  Yes

  No

  N/A

• Cords in Good Repair

  Yes

  No

  N/A

• Panels are Sealed

  Yes

  No

  N/A

• Temp. Lighting Good

  Yes

  No

  N/A

Heavy Equipment

• Back-up Alarm

  Yes

  No

  N/A

• Seat Belts

  Yes

  No

  N/A

Crane

• Safety Latch on Hook

  Yes

  No

  N/A

• Swing Barricaded

  Yes

  No

  N/A

• Tag Line Available

  Yes

  No

  N/A

Traffic Control

• Traffic Control Person

  Yes

  No

  N/A

• Reflective Vest/Sign

  Yes

  No

  N/A

Health Conditions

• Proper Ventilation

  Yes

  No

  N/A

• Drinking Water/Cups

  Yes

  No

  N/A

• Clean Restrooms

  Yes

  No

  N/A

Additional Remarks/Comments

• It is expected that identified items will be suitably addressed by the responsible contractor's "Competent Person".

• Survey completed and distributed by:

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• Select date

  Date