Information
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Conducted on
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Location and job number
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Operation being performed
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Name of person completing audit
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Personnel
Directions:
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When performing the safety audit answer yes, no, or n/a to the following. If the answer is no, double click the item to add the violation/concern and a corrective action.
Project Set Up
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Tool-box talk had been conducted (daily)
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Adequate supply of clean water and soap for washing (waterless soap is adequate)
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Adequate supply of drinking water and cups (specific container for drinking water only)
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Eyewash station, bottles, or other designated source is on-site and readily available
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Shooter is in proper working condition
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One person CPR/First Aid trained on site at all times
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Scaffolding is properly erected and determined safe prior to us (fall restraint being utilized)
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Emergency numbers are posted and crew members have the means to summon help in case of emergency
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Is housekeeping neat and in order?
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Equipment and tools neat and organized?
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Supt/foreman have the necessary field handoff package?
Traffic & Vehicle Safety
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Traffic control equipment, devices, and barricades are appropriately set up
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Hose guards are protected with hose guards from traffic and other possibility of damage
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Vehicles have serviceable fire extinguisher mounted and warning triangles/flares
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Clean, serviceable first aid kit in each vehicle and job trailer
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Vehicle pre-trip inspections are current and available
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When necessary, vehicles and all mobile equipment (including pumps, compressors, etc.) have wheels chocked
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Is equipment sake and in good working condition?
PPE and Personnel Hazards
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Minimal PPE required is being worn (steel-toed boots, reflective vest, 3" sleeved t-shirt, jeans, hard hat)
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Additional PPE is being utilized if need be (safety glasses/goggles, gloves, hearing protection)
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Employees are not wearing inappropriate items such as shorts, baggy shirts, loose jewelry. Additionally long hair is pulled back and kept out of way.
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Appropriate respirators are being used for the right environment and only being worn by employees that have been fit tested and are clean shaven
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Storage area for respirators and they are being kept there
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Subcontract employees are adhering to the safety rules of SAK
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Temporary laborers are performing tasks only for which they have received training
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Proper tool(s) being used for the task?
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All tools in good working condition with guards in place?
Confined Space Entry
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Appropriate work permits (hot work, confined space entry, etc.) are posted and in use at manhole
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Qualified attendant is present during entries
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Attendant is properly equipped and trained in rescue procedures
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Entrants are wearing body harnesses, lanyards, and attached to fall restraint device (tripod)
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Serviceable tripod is available for use
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Gas detectors on site have been calibrated on 30 day cycles. Additionally have calibration stickers on front.
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Two reliable forms of communication are being used and are available
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Plugging is installed, secured, and is monitored with a working pressure gauge
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Bypass pumping is installed and is monitored
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Smoking is permitted in designated areas on (10ft or more away from manholes, away from fuels, chemicals, etc)
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Open manholes are protected (barricades, signs, etc.)
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SSSP is being followed if required and necessary steps are being taking to ensure implementation
Hazards Communication, Chemical, and Fuel Safety
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Precautions against burns from steam burns are provided
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Material Safety Data Sheets (MSDSs) are readily available for all chemicals/cleaners on site
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Chemicals are stored in approved containers are are properly labeled
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Company Hazard Communication Programs are being followed
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Employees are aware of applicable chemical/physical/exposure hazards, and protective means
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Gasoline and other flammable chemicals are in automatic closure containers with flame arrestor
Boiler Unit
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Equipped with burn kit and/or water gel burn blankets and pads
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Precautions against burns from steams bursts are provided
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Precautions against splashing and other discharges of heated water (shooter, top-hat overflow, etc.) are provided
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Are hoses in good condition?
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Are drain valves in place?
Electrical
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Electrical equipment is grounded as required and all three prong plugs are in good condition
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Ground fault (GFCI) receptacles are being utilized with all electrical power tools
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All electrical boxes are closed and in good condition
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Only round construction grade extension cords are being used and are protected from damage
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Extension cords are in good shape free from any damage/electrical tape
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Are all the cords from power tools and equipment in good working condition?
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Policy on ground fault?
Signature
Comments
After completing audit, there will be an overall score given for audit. What do you think this site scored on a scale from 1-low to 10-high?
By signing you are acknowledging that you have read and will make efforts to correct safety violations and hazards
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Foreman
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Superintendent
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Safety Manager
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Asking me to overlook a simple safety violation would be asking me to compromise my entire attitude toward the value of your life.
