SEDD Monthly Safety Audit

• Client / Contractor

• Conducted on

  Date

• Prepared by

• Location
  Address

• Current Crew:

Jobsite

• Closest expiration date and name from First-aid kit:

• AED is charged and has pads with it?

  Yes

  No

  N/A

• Expiration date of AED pads:

• State labor poster is posted and is for the correct state?

  Yes

  No

  N/A

• Hard hats and safety glasses are stocked and meet ANSI standards?

  Safe

  At Risk

  N/A

• Safety vests and shirts are worn and free of excessive mud?

  Safe

  At Risk

  N/A

• Correct gloves are stocked and worn by all employees?

  Safe

  At Risk

  N/A

• Ear plugs and dust mask are stocked and worn when required?

  Safe

  At Risk

  N/A

• Hard hat mounted face shield is worn when required?

  Safe

  At Risk

  N/A

• Welding helmet is worn when welding?

  Safe

  At Risk

  N/A

• Welding gloves and sleeves are stocked and worn?

  Safe

  At Risk

  N/A

• Gas/Diesel cans are not plastic and are contained in a containment area in one place?

  Safe

  At Risk

  N/A

• Visqueen is in place with no tears or leaks?

  Safe

  At Risk

  N/A

• Spill kits are present and visible?

  Safe

  At Risk

  N/A

• Fork lift has been inspected daily with logged documentation, has no leaks, and properly working brakes?

  Safe

  At Risk

  N/A

• Pallet forks are free of major rust, have no cracks, and are certified?

  Safe

  At Risk

  N/A

• Drill rig has a properly working e-stop, and has no major issues or leaks?

  Safe

  At Risk

  N/A

• Mud system has a properly working e-stop, and has no major issues or leaks?

  Safe

  At Risk

  N/A

• Track hoe/Excavator has been inspected daily with logged documentation, has no leaks, and properly working brakes?

  Safe

  At Risk

  N/A

• Fire extinguisher is on all major equipment/DOT vehicles?

  Safe

  At Risk

  N/A

• Fire extinguisher rating meets the ABC standard?

  Safe

  At Risk

  N/A

• Fire extinguisher annual has been done less than one year ago, and has been inspected every 30 days with no missing parts?

  Safe

  At Risk

  N/A

• Fire extinguisher has not been used, and if it has been used has been serviced since use?

  Safe

  At Risk

  N/A

• All employees have been trained in the use of a fire extinguisher?

  Safe

  At Risk

  N/A

• Fire extinguisher has been mounted securely with the proper bracket and 75 feet apart?

  Safe

  At Risk

  N/A

• JSA copies are on rig for duration of the project, copies have been turned in to the office, and contractor has been given a copy if they requested it?

  Yes

  No

  N/A

• Wellness form has been turned in to the office?

  Yes

  No

  N/A

• Good Catch & BBS Cards are stocked and available to all employees?

  Yes

  No

  N/A

• SDS sheets are marked, available to all employees, and the location is well known?

  Yes

  No

  N/A

• First-aid kit is stocked and up to date?

  Yes

  No

  N/A

Comments:

• Rig Number

  Yes

  No

  N/A

• Preparer signature:

  Sign

• Rig Supervisor (if different from preparer)

  Sign