Title Page
-
Audit Title
-
Prepared by
-
Conducted on
-
Job #
-
Client / Site
Division
-
Civil
-
Shop
-
Task:
Directions
-
1.) All observations will include Personal Protective Equipment (PPE)
2.) Check the box next to each task category that you observed.
3.) Write the number of workers observed SAFE and the number at-RISK.
4.) If an item is not observed, leave it blank.
5.) Describe each at-RISK observed and indicate the action(s) taken to correct.
Personal Protective Equipment
-
Head Protection
-
SAFE
-
RISK
-
Eye Protection
-
SAFE
-
RISK
-
Face Protection
-
SAFE
-
RISK
-
Respiratory Protection
-
SAFE
-
RISK
-
Foot Protection
-
SAFE
-
RISK
-
Hand Protection
-
SAFE
-
RISK
-
Hearing Protection
-
SAFE
-
RISK
-
Personal Gas Meter
-
SAFE
-
RISK
Equipment Use
-
Pre-shift inspection
-
Fire extinguisher on equipment
-
Seat belts (where required)
-
Backup alarm/spotters
-
3 points of contact (climbing on/off equipment)
-
Safe management of load
-
Clear visibility/route for driving
-
Workers clear of equipment/material
-
Safe movement of equipment
-
Clearance from obstacles/spotter
-
Operators training up to date
-
Equipment properly attended
Confined Space
-
Confined space re/evaluation completed
-
High hazard meeting conducted
-
Gas testing performed
-
Permit issued properly (if required)
-
Attendant present
-
Rescue available (if required)
-
Entrants tracked (sign in/sign out)
Barricading
-
Barricade present and enclosed jobsite
-
Proper type of tape
-
Proper tags and contact information
General Work Practice
-
JSA used properly
-
Permit issued and filled out correctly
-
Hazard identification/avoidance
-
Fall Protection (when required)
-
3 points of contact (stairs, ladders, equipment)
-
Proper lifting technique
-
Clear route for walking/driving
-
Body positioning (awkward/overreach)
-
Tools in good working condition
-
Housekeeping maintained
-
Pinch points avoidance
-
Knowledge of gas alarm levels
-
Danger zone avoidance
-
Recall of pre-shift meeting
Lock Out/Tag Out
-
Equipment de-energized
-
Locks and tags properly used
-
Employee notifications made
-
LOTO/ECP procedure followed
-
Equipment tried out for verification
Hot Work
-
Fire watch present
-
Sparks contained
-
Combustible removed
-
Extinguisher or fire hose present
-
Hot work permit present
Summary
-
Risk Description:
-
Action(s) Taken:
