Safety Survey

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Select date

  Date

Housekeeping

• Garbage & debris regularly removed from the site?

  Yes

  No

  N/A

• Materials adequately stored?

  Yes

  No

  N/A

• Is lighting adequate for workers and the public?

  Yes

  No

  N/A

Fall Protection

• Are guard rails adequately installed?

  Yes

  No

  N/A

• Are hole covers adequately placed over floor openings?

  Yes

  No

  N/A

• Are perimeters adequately protected?

  Yes

  No

  N/A

• Are vertical nets adequately installed?

  Yes

  No

  N/A

• Are horizontal nets adequately installed?

  Yes

  No

  N/A

• Are Controlled access zones in place?

  Yes

  No

  N/A

• Is the cocoon system in place as per design drawings?

  Yes

  No

  N/A

Scaffolds

• Are guardrails adequately installed?

  Yes

  No

  N/A

• Is the scaffold stable?

  Yes

  No

  N/A

• Is the access to the scaffold adequate?

  Yes

  No

  N/A

• Is the scaffold inspected by a competent person?

  Yes

  No

  N/A

• Are scaffold users and erectors trained?

  Yes

  No

  N/A

Ladders

• Are ladders secured?

  Yes

  No

  N/A

• Are the appropriate ladders being used per task?

  Yes

  No

  N/A

• Are all Ladders onsite in compliance?

  Yes

  No

  N/A

Electrical

• Are the electrical panels secure?

  Yes

  No

  N/A

• Is there a Lock out Tag out system in place?

  Yes

  No

  N/A

• Are panels sealed?

  Yes

  No

  N/A

• Are panels and breakers labeled?

  Yes

  No

  N/A

• Are workers using GFCI's?

  Yes

  No

  N/A

• Are lead lines and extension cords protected ?

  Yes

  No

  N/A

Concrete

• Is the rebar adequately protected?

  Yes

  No

  N/A

• Are shores & restores secured?

  Yes

  No

  N/A

• Are pour stops secured

  Yes

  No

  N/A

• Are workers using proper PPE?

  Yes

  No

  N/A

• Are gang ladders built to ANSI standards?

  Yes

  No

  N/A

Steel

• Is steel secured?

  Yes

  No

  N/A

• Are workers tethering their tools?

  Yes

  No

  N/A

• Are hot work permits issued for welding?

  Yes

  No

  N/A

• Are iron workers using proper PPE?

  Yes

  No

  N/A

• Are fire guards in place?

  Yes

  No

  N/A

• Are welding shields and fire retardent blankets in use?

  Yes

  No

  N/A

• Are iron workers trained?

  Yes

  No

  N/A

Personal Protective Equipment (PPE)

• Are Personal Fall Arrest systems inspected?

  Yes

  No

  N/A

• Are workers using proper PPE?

  Yes

  No

  N/A

• Is PPE adequately being maintained/stored?

  Yes

  No

  N/A

Excavation

• Is the excavation adequately protected?

  Yes

  No

  N/A

• Is the egress from the excavation adequate?

  Yes

  No

  N/A

• Are adjacent structures adequately supported?

  Yes

  No

  N/A

• Is the excavation inspected daily?

  Yes

  No

  N/A

• Are CAZ or barricades adequately placed?

  Yes

  No

  N/A

Fire Prevention

• Are fire extinguishers in place as required?

  Yes

  No

  N/A

• Is the standpipe maintained?

  Yes

  No

  N/A

• Are sprinklers maintained?

  Yes

  No

  N/A

• Is the siamese connection unobstructed?

  Yes

  No

  N/A

Traffic Controls

• Are barricades adequately maintained?

  Yes

  No

  N/A

• Are flagmen trained?

  Yes

  No

  N/A

• Are flagmen in place as required?

  Yes

  No

  N/A

Public

• Is the public protected?

  Yes

  No

  N/A

• Is there an adequate tenant protection plan?

  Yes

  No

  N/A

Safety

• Are HASP filed with the GS?

  Yes

  No

  N/A

• Are JHA's being used?

  Yes

  No

  N/A

• Is the site inspected periodically?

  Yes

  No

  N/A

Accidents/Incidents

• Has the site been accidents free for the past 30 days?

  Yes

  No

  N/A

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