Sampson Construction

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

General Safety/Health/ Environmental Controls

• Postings: 300 log, Posters, Emergency Phone Numbers, Emergency Action Plan.<br>

  Safe

  At Risk

  N/A

• Programs: Safety Policy, SDS's, HAZCOM, Bracing Plan, Training, Erosion Control Plan: SWPPP, ONE CALL, Confined Space Permit

  Safe

  At Risk

  N/A

• First Aid: F/A Kit, BBP Kit, Eyewash Station Available.

  Safe

  At Risk

  N/A

• Housekeeping/Sanitation/Ventilation: Potable Water, Washing Facility, Vermin Control, Toilets Acceptable, Dust buildup, Hazardous Gasses; CO, Lead, Asbestos.

  Safe

  At Risk

  N/A

• Illumination: Proper lighting egress routes.

  Safe

  At Risk

  N/A

• Signs, Signals and Barricades, Site Security.<br>

  Safe

  At Risk

  N/A

• Proper PPE, Hardhat, Safety glasses, Dust Mask, Gloves, Boots, etc.

  Safe

  At Risk

  N/A

Subpart F Fire Protection

• Fire Ext. General Conditions, Fire Ext. Hot Work, Hot Work Permit, Flammable Liquids, Fuel Gas Storage, ILSM, Temporary Heating.

  Safe

  At Risk

  N/A

Subpart H Material Handling/Storage

• Storage of Material, Disposal of Material, Material Handling

  Safe

  At Risk

  N/A

Supbart I Tools

• Hand Tools, Power Tools, Pneumatic hose secured, Guards in place

  Safe

  At Risk

  N/A

Subpart J Welding and Cutting

• Guages, Hoses and Tanks acceptable and secured, Fire Prevention, Weld Cables,

  Safe

  At Risk

  N/A

Subpart K Electrical

• LOTO, Temp Light, Cords and conductors acceptable, Panels Labeled and secure, Wiring Methods, Guarding of live parts

  Safe

  At Risk

  N/A

Subpart L Scaffold

• Scaffold: Mudsill, Base plate, Wheels Locked, Level, Braced, Fully Decked, Access @2', Guardrail @10', Secured from displacement, Loaded properly

  Safe

  At Risk

  N/A

• Scissors Lift, Chain Secure, Feet on Platform, Inspected<br>Aerial Lift, Feet on Platform, Fall Protection

  Safe

  At Risk

  N/A

Subpart M Fall Protection

• Fall Prevention: Guardrails 42", Midrail 21", Toeboard. Hole Covers, Safety Nets, Warning Line, CAZ, Limited access Zone

  Safe

  At Risk

  N/A

• Fall Arrest/Positioning Systems: Proper Anchorage, Harness, Lanyard, Retractable, Rope Grab, ETC.

  Safe

  At Risk

  N/A

Subpart N/CCC Cranes, Derricks, Hoists, Elevators

• Operator Certified, Annual and Daily Inspection, Stable Foundation, Swing Radius Barricaded, Signal Person and Rigger Qualified

  Safe

  At Risk

  N/A

• Rigging, Critical Lift Plan, Assembly, Disassembly Plan, Overhead Power, Traffic Control and Public Protection, Hoisting Personnal

  Safe

  At Risk

  N/A

Subpart O Motor Vehicles and Equipment

• Training Card, Seat Belt, ROPS, Backup Alarm, Signage, Inspection

  Safe

  At Risk

  N/A

Subpart P Excavation

• Protective Systems ie. Benching/Sloping/Shielding 4', Access/Egress at 4', Inspection of Trench, One Call?, Barricade, Traffic Control, High Vis. Clothing, Spoil Pile/ Falling loads, Adjacent Structure

  Safe

  At Risk

  N/A

Subpart Q Concrete and Masonry

• Bracing Plan, Post Tension, Shoring/Reshoring Plan, Impalement Protection, Pump Truck Safety,

  Safe

  At Risk

  N/A

Subpart R Steel Erection

• Fall Protection/CDZ, Erection Plan/Bracing Plan, Hoisting and Rigging, Steel Assembly, Anchor Bolts, Overhead Protection, Falling Object Protection

  Safe

  At Risk

  N/A

Subpart T Demolition

• Demo Plan, Asbestos/Lead Survey/PCB Survey, Engineering Survey, Shoring/Bracing, Dust Control, Material Removal

  Safe

  At Risk

  N/A

Subpart X Stairway and Ladder

• Extension Ladder secured/extended 36" above landing, Proper ladder use, Inspection.

  Safe

  At Risk

  N/A

• Stairways, pans filled, handrail, Landing Guardrail, No storage in Stairway.

  Safe

  At Risk

  N/A