Information

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • Job #

  • Sunny

  • Rainy

  • Cloudy

  • Windy

  • Hot

  • Cold

  • Temperature

  • State and Federal Listing posted at the site<br>

  • Daily Job Safety Analysis reviewed, updated and signed

  • Emergency contact list posted

  • Weekly safety meetings being completed

  • Weekly equipment checklist completed

  • Copy of safety manual, MSDS, tabulated data

Subcontractor Compliance

  • Subcontractor per-construction meeting completed and documented.

  • Drug testing information collected.

  • Subcontractors have submitted training documentation for he task that will perform.

  • Subcontractors have completed a JSA for the task that they will complete. <br><br><br><br>

  • Subcontractors have completed and submitted weekly safety meetings.

  • Subcontractors are complying with PPE requirements.

Personal Protective Equipment (PPE)

  • Eye protection including side shields (100%)

  • Head protection (100%)<br>

  • Hearing protection required and worn

  • High visibility clothing / vests worn by none burning or climbing employees.(100%)

  • Respiratory protection equipment worn and stored properly where required.

  • Speciality PPE (face shields, FR clothing)

Fall Protection

  • Fall protection required (All work over 6' requires fall protection)

  • Have all employees who are working at height (6' or greater) trained in fall protection.

  • Have the fall hazards been addressed in a JSA

  • Harnesses, SRL's, and fall protection equipment has been inspected before use and in good condition

  • What form of rescue will be used in the event a fall takes place.

Holes

  • Have all holes been properly protected. (2" or greater)

  • Have all hole covers been properly secured, and markerd with the words" HOLE".

Guardrails

  • Toprail 42+/- 3", Midrail 21+/3", Toe board.

  • Cable Guardrail: Top rail 42" +/- 3", do not deflect below 39". <br>

  • Stanstions on 8' centers. <br>

  • Flagging placed every 6'.

  • Free from laceration hazards.

  • Completely protects against the hazard.

Ladders & Barricades

  • Have all ladders been inspected before use.

  • Do ladders have proper footing.

  • Are ladders used in a dully opened position.

  • Is the ladder positioned so the base of the ladder is one foot away for every four feet of height. (4:1 ratio)

  • Do side rails extend 36" above the landing area.

  • Have ladders been properly secured.

  • Employees maintaining 3 points of contact when using the ladder.

  • Can work be performed within the confines of the side rails.

Excavation Safety

  • Has a Competent person been assigned to the task

  • Has the Utility One Call been made. Are marking updates being made, and information being received.

  • Have underground utilities been identified / located and marked

  • Have adjacent structures / utilities been properly protected or supported. <br>

  • Has the trench / excavation been inspected before entry's

  • Is a ladder or acceptable means of egress provided in all trenches / excavations 4' or deeper

  • Are excavations 5' deep or deeper properly protected. (Sloped, bench, shielded, or shored)

  • Are trench boxes in good condition, spreaders properly installed, stacking pins in place. <br><br>List Box numbers:<br><br><br>

Vehicles & Equipment

  • Is all equipment equipped with a fire extinguisher (Extinguishers inspected and up-dated)<br><br><br>

  • Are all safety devices in place and working (Back-up alarms, etc..)<br>

  • Power lines de-energized and/or safe distance from equipment (10 feet)

  • Is demolition equipment equipped with safety cages (Including hammering operation)

  • Aerial lifts inspected and used properly (Controls inspected and tested daily)

  • Crane operators NCCO License current and on file.

  • Daily crane inspection completed

  • Swing radius protected

  • Prelift form completed before all lifts.

  • Rigging inspected before all lifts.

  • All chains / nylon / wire rope slings labeled.

  • Shackles and hooks inspected for deformation, keepers present.

  • Loads rigged by a qualified rigger.

  • Crane maintaining 20' from overhead powerlines, or if voltage is known, following Table A.

Material Handleing and Concrete Construction

  • Men lifting correctly.

  • Are form brackets inspected.

  • Walkways over rebar mats.

  • Has all reinforcement bar that presents an impalment, or cut hazard been protected

  • Materials properly stored, labeled and stacked.

Housekeeping and Sanitation

  • General neatness of the working areas

  • Tool trailer & conex organized and clean.

  • Proper and safe access and egress to tool trailers and offices.

  • Waste containers provided and used.

  • Adequate supply of drinking water on-site.

  • First aid equipment on-site and accessible.

  • Sanitary facilities adequate and clean.

  • Traffic Safety

  • Barricades

  • Cones

  • Signs

  • Is signage properly placed

  • Are pedestrian crossings good

  • General comments about site.

  • Superintendent Name

  • Foreman signature

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.