Self - Safety Audit

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Rate each area by checking the appropriate box. Describe the hazard and corrective action. Document positive responses by "tapping" the left edge of the box.

• 1. Housekeeping

  Safe

  At Risk

  N/A

• 2. Confined Space

  Safe

  At Risk

  N/A

• 3. Working at Heights

  Safe

  At Risk

  N/A

• a. Floor/Wall Openings

  Safe

  At Risk

  N/A

• b. Guardrails

  Safe

  At Risk

  N/A

• c. Ladders

  Safe

  At Risk

  N/A

• d. Aerial Lifts

  Safe

  At Risk

  N/A

• e. Scaffolding

  Safe

  At Risk

  N/A

• 4. Excavations/Duct Bank

  Safe

  At Risk

  N/A

• 5. Electrical

  Safe

  At Risk

  N/A

• a. GFCI

  Safe

  At Risk

  N/A

• b. Cords/Assured Grounding

  Safe

  At Risk

  N/A

• c. Lockout Tagout

  Safe

  At Risk

  N/A

• d. Temporary Lights & Power

  Safe

  At Risk

  N/A

• 6. Signs/Barricades

  Safe

  At Risk

  N/A

• 7. Access/Egress

  Safe

  At Risk

  N/A

• 8. Material Storage

  Safe

  At Risk

  N/A

• 9. Compresses Gases

  Safe

  At Risk

  N/A

• 10. Personal Protective Equipment

  Safe

  At Risk

  N/A

• a. Hard Hats

  Safe

  At Risk

  N/A

• b. Safety Glasses

  Safe

  At Risk

  N/A

• c. Fall Protection Gear

  Safe

  At Risk

  N/A

• d. Gloves

  Safe

  At Risk

  N/A

• e. NFPA 70E Gear

  Safe

  At Risk

  N/A

• f. Hearing Protection

  Safe

  At Risk

  N/A

• g. Respirators

  Safe

  At Risk

  N/A

• 11. Fire Prevention/Extinguishers

  Safe

  At Risk

  N/A

• 12. Equipment Inspection

  Safe

  At Risk

  N/A

• a. Tools/Machines

  Safe

  At Risk

  N/A

• b. Aerial Lifts/Fork Lifts

  Safe

  At Risk

  N/A

• c. Vehicles

  Safe

  At Risk

  N/A

• 13. Drinking Water/Cups

  Safe

  At Risk

  N/A

• 14. Is an MSDS Book available?

  Yes

  No

  N/A

• 15. Is a Health & Safety Manual available?

  Yes

  No

  N/A

• 16. First Aid Kit/Emergency Information

  Safe

  At Risk

  N/A

• 17. Other

  Safe

  At Risk

  N/A

Other Jobsite Comments

• Any good things to note about the jobsite?

• Any General Contractor comments or concerns?

Are the following being completed on this jobsite?

• Daily Pre-Task Plans

• Weekly Safety Talks

• Daily Stretching