Saftey Assessment

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

A. Personal Protective Equipment

• Hard Hats in use by all personnel

  Safe

  At Risk

  N/A

• Eye protection in use by all personnel

  Safe

  At Risk

  N/A

• Hearing protection (engineering controls, double protection for high noise areas, rotation of employees)

  Safe

  At Risk

  N/A

• Proper foot gear and protective clothing (reflective vests)

  Safe

  At Risk

  N/A

• Fall protection in use

  Safe

  At Risk

  N/A

• Respirators/face masks in good condition and used as required (Medical evaluation and fit test)

  Safe

  At Risk

  N/A

Tools and Equipment

• Tools and equipment in good condition

  Safe

  At Risk

  N/A

• All equipment in good condition

  Safe

  At Risk

  N/A

• Electrical equipment connected properly, grounded and in good condition; GCFI; automatic magnetic cut-off for wood working tools

  Safe

  At Risk

  N/A

• Machine guards/pinch points identified/protected

  Safe

  At Risk

  N/A

• Rigging/Lifting equipment in good condition and inspected

  Safe

  At Risk

  N/A

• Ladders in good condition; tied back; extended 3 ft. beyond landing

  Safe

  At Risk

  N/A

Heavy Equipment

• Daily inspection completed

  Safe

  At Risk

  N/A

• Fire extinguisher mounted and in good condition

  Safe

  At Risk

  N/A

• Seatbelt worn during operation

  Safe

  At Risk

  N/A

• Backup alarm operable/guide used

  Safe

  At Risk

  N/A

Hazardous Chemicals/Air Contaminants

• Hazard communication-right to know poster / written program on job

  Safe

  At Risk

  N/A

• List of hazardous materials on job

  Safe

  At Risk

  N/A

• Material Safety Data Sheets

  Safe

  At Risk

  N/A

• Employees are familiar with program

  Safe

  At Risk

  N/A

• Proper containers in use with correct labels

  Safe

  At Risk

  N/A

General

• Safe access to work area

  Safe

  At Risk

  N/A

• Good housekeeping and material storage

  Safe

  At Risk

  N/A

• Barricades/debris protection/ warning signs in place

  Safe

  At Risk

  N/A

• Excavation/ Trenches properly protected

  Safe

  At Risk

  N/A

• Shoring properly installed; engineers stamp on drawings

  Safe

  At Risk

  N/A

• Eye wash available

  Safe

  At Risk

  N/A

• Fire extinguisher; Good condition; current inspection tag; within 50'

  Safe

  At Risk

  N/A

• First Aid kit and certified employees

  Safe

  At Risk

  N/A

• Trucks; safe/good condition; DOT regulation compliance

  Safe

  At Risk

  N/A

Paperwork and other Postings

• OSHA poster/log

  Safe

  At Risk

  N/A

• Emergency phone number card

  Safe

  At Risk

  N/A

• Daily Pre-Task card reviewed

  Safe

  At Risk

  N/A

• SWPPP inspection/ documented

  Safe

  At Risk

  N/A

• I9's logs up to date

  Safe

  At Risk

  N/A

• Add signature

  Sign

• Select date

  Date