Project and Site Details

  • Site name

  • Property Owner

  • Number of personnel on site:

  • Crew Foreman/Leader

  • Scope of Work

  • Are there any subcontractors on site?

  • Subcontractor Name

  • Number of Personnel on Site
  • Project Manager

  • Will elevated work occur on this project site?

  • Monopole

  • Self-Supporting Tower

  • Guyed Tower

  • Water Tank

  • Rooftop

  • Crane Supported Work Platform

  • Man Basket

  • Aerial Lift of Scissor Lift

  • Bucket/Boom truck

  • Other

  • Describe:

  • Insert photo of structure where elevated work is occurring or will occur.

Jobsite Documentation

  • Is a Daily Safe Plan of Action or a Job Hazard Analysis completed and on site?

  • Rate the quality and completeness of the SPA, with a 0 being poor quality and 10 being high quality.

  • Is a Safety Binder on site with all required documentation?

  • Are originals or copies of the Competent Climber certifications of all personnel who will work at elevation available on site?

  • Is there a completed Emergency Action Plan for the site?

  • Is there a Competent Persons list on site?

  • Are there at least 2 persons on site currently certified in First Aid/CPR?

  • Is a first aid kit on site?

  • Are overhead utilities and other electrical hazards addressed in the SPA/JHA?

  • Are overhead or underground utilities present?

  • Are MSDS's available on site for all chemicals, compounds, and hazardous substances?

  • Overall compliance with field site documentation requirements:

  • Describe deficiencies:

  • Deficiency
  • Deficiency

  • Add media

  • Document remedial actions taken:

Jobsite Contitions

  • Is the worksite clean of trash and debris?

  • Are materials stored properly and orderly?

  • Are measures taken to prevent access to the site by unauthorized personnel?

  • Are work areas barricaded or fenced?

  • Is there signage posted at the entrance to the site establishing PPE and access instructions for visitors?

  • Is drinking water available?

  • Are chemical, flammable and combustilble liquids stored properly? (No plastic storage cans)

  • Is there adequate number of fire extinguishers available, fully charged and with current inspection?

  • Proper sized water wagon on site?

  • Are weather (heat, cold, precipitation, lightening, ice/snow) addressed and documented on the SPA?

  • Overall compliance with jobsite conditions management

  • Describe Deficiencies:

  • Deficiency
  • Deficiency:

  • Insert Photo of Deficiency, if applicable.

  • Describe remedial actions taken:

PPE

  • Are employees wearing hard hats 100% of the time?

  • Document remedial actions taken:

  • Hard hat(s) less than 5 years old, show no signs of cracks, or holes?

  • Are employees weating ANSI Z87 safety glasses 100% of the time?

  • Document remedial actions taken:

  • Are employees wearing appropriate gloves for the tasks performed 100% of the time?

  • Document remedial actions taken:

  • Are employees wearing hi-viz clothing while heavy equipment is being used?

  • Document remedial actions taken:

  • Are employees wearing appropriate hard-toe footwear?

  • Document remedial actions taken:

  • Are employees dressed in appropriate work clothing?

  • Document remedial actions taken:

  • Is hearing protection needed for potential noise exposures over 85dB?

  • Are ear plugs or ear muffs available for employees on site?

  • Are employees with exposures to noise over 85dB wearing appropriate hearing protection?

  • Document remedial actions:

  • Other PPE in use on this site:

  • Other PPE needed on this site:

  • Overall compliance with PPE requirements:

Fall Protection

  • Do employees who are exposed to falls have proper training?

  • Document remedial actions taken:

  • If fall protection equipment being inspected daily and documented on the Elevated Work Permit?

  • Document remedial actions taken:

  • Are all inspection tags on fall protection equipment present and legible?

  • Document remedial actions taken:

  • Are all carabiners used a minimum of 25kn (5620lbs)?

  • Are all carabiners self closing and self locking?

  • Are inspection tags on climbing harness legible?

  • Are climbing harness in working order and do not exceed 5years of use?

  • If the work performed requires fall protection, is it being used 100% of the time?

  • Persons in violation of 100% fall protection shall be removed from site. Further disciplinary procedures may apply.

  • Document remedial actions taken.

  • Is work being performed on a rooftop or other elevated flat surface?

  • Are the following conditions met?

  • Overall compliance with Fall Protection requirements:

  • See specific remedial actions above and recommendations in Section 15.

RF

  • Have RF hazards been considered and the safe plan documented on the Safe Plan of Acton?

  • Is there a procedure in place to reduce RF exposure, if applicable?

  • Does client of site owner require specific RF protection plans?

  • Are our operations on site in compliance with client and owner requirements?

  • Document remedial actions:

Hoists

  • Is hoist operator qualified (Certified through training or Qualified through experience)?

  • Document remedial actions taken:

  • Are daily inspections being completed with documentation on site?

  • Is there an operators manual for the unit(s) on site?

  • Are the load charts readily available for hoist operators?

  • Are all hoists secured and properly anchored for the load intended?

  • Is the end connection properly secured?

  • Are hoist controls clearly identified?

  • Are hoist controls easily accessbile to the operator?

  • Are all exposed parts properly guarded?

  • Is the hour meter operational and functioning properly?

  • Detail Hoist Unit Condition and Hours

  • Hoist
  • Hoist Unit

  • Condition:

  • Hours:

  • Overall compliance with hoist safety requirements:

  • Comments or remedial actions required:

Cranes

  • Is there crane work associated with this project?

  • Document remedial actions taken:

  • Overall compliance with crane requirements?

  • Have crane picks been planned and the plans documented?

  • Has the crane subcontractor submitted proof of annual inspection of the crane?

  • Has the crane subcontractor submitted evidence of the crane operator's NCCCO certification?

  • Does the crane signal person have current certification?

Elevated Work Platforms & Aerial Devices

  • Are Elevated Work Platforms or other Aerial Work Devices being used or to be used on this site?

  • Is the crane approved for lifting personnel?

  • Does the personnel platform have an identification plate with weight of the platform, maximum intended load and personnel capacity?

  • Was the Crane Suspended Work Platform planning checklist completed and made available on site?

  • Has a pre-lift meeting been held, documented and made available on site?

  • Was a trial lift completed and documented?

  • Does the daily Safe Plan of Action adequately address the type of elevated work platform and hazards associated with the device?

  • Were additional checklists or planning documents used to plan this work?

  • Are all personnel performing elevated work using 100% fall protection?

  • Are the equipment operators Qualified to operate the device?

  • Overall compliance with elevated work platform and aerial device requirements:

  • Describe remedial actions taken:

Rigging and Blocks

  • Will there be rigging of equipment, materials or tools to be hoisted on this site?

  • Are proper rigging practices being utilized?

  • Are Riggers properly Qualified for the rigging work performed?

  • Qualification is based upon:

  • Is rigging equipment in good condition?

  • Is rigging equipment being inspected daily and the inspection documented on the daily Safe Plan of Action or Elevated Work Permit?

  • Has the equipment been thoroughly inspected on a quarterly basis and the inspection documented?

  • Are ropes in good condition?

  • Are tag lines in good condition?

  • Overall compliance with rigging and blocking requirements:

  • Describe remedial actions taken:

Gin Poles

  • Are gin poles in use or to be used on this site?

  • Has the gin pole been inspected prior to use, and is the inspection available on site?

  • Does the sheave in the rooster head match the wire rope?

  • Has the daily safe plan of action addressed the use and hazards associated with gin poles?

  • Have other checklists been used to plan the work?

  • Is gin pole being used in accordance with all requirements in Construction and Demolition of Telecommunications Towers?

  • Document remedial actions taken:

  • Is the gin pole rigging in good condition?

  • Does the gin pole have an identification tag?

  • Does the gin pole have a rated hoisting capacity?

  • Are all intended loads less than 85% of the capacity of the gin pole?

  • Document remedial actions taken:

Ladders

  • Are all ladders on site rated at lease A1?

  • Are all ladders on site in good condition?

  • Has a daily pre-work inspection been completed of all ladders in use, and is the inspection noted in the daily Safe Plan of Action or available on site?

  • Are A-frame ladders set up correctly with legs fully opened and locked in place?

  • Are extension ladders set up at the proper slope of 4:1?

  • Do extension ladders extend at least 36" above the landing level?

  • Are ladders only set up on stable and level ground?

  • Overall compliance with Ladder safety requirements:

  • Deficiencies Noted:

  • Deficiency
  • Describe deficiency:

  • Insert photo of non-compliant item

  • Describe remedial actions taken:

Electrical

  • Are extension cord sets appropriate gauge for load?

  • Are construction rated GFCIs used on all circuits greater than or equal to 120-volt, 15-20 amperes which are not connected to a building system?

  • Is all cord set insulation in good condition? No nicks or cuts or frays?

  • Do all cord sets have molded male and female end plugs with no gaps?

  • Are all cover plates in place on outlets?

  • Is any work occurring on live circuits greater than 50 volts AC or 100 volts DC?

  • What type of work is occurring?

  • Has an Arc Flash Hazard Analysis been conducted on the potential exposures and/or have the specific hazards been identified and a control plan put in place?

  • Are work areas clearly marked and barricaded from unauthorized entry?

  • Are all hand tools voltage-rated insulated tools?

  • Overall Compliance with electrical safety requirements:

  • Deficiencies Noted:

  • Deficency
  • Describe deficiency

  • Insert photo of deficiency, if applicable.

  • Document remedial actions taken:

Excavations

  • Does the scope of work on site include excavation?

  • Is the operator Qualified to operate excavation equipment?

  • Are designated safe walk paths or No Pedestrian zones established?

  • Are back-up alarms functioning on all mobile equipment?

  • Has the Pre-Excavation checklist been completed and made available on site?

  • Are overhead and underground utilities identified and clearly marked?

  • Is there potential that personnel may enter the excavation while it is open?

  • How deep will the excavation be at its deepest point?

  • Is a safe means of ingress and egress provided at least every 25-feet?

  • Will the excavation exceed 5-feet deep at any point?

  • Indicate means to prevent trench collapse:

  • Describe other means of preventing trench collapse:

  • Overall compliance with trenching and excavation requirements:

  • Deficiencies Noted:

  • Deficiency
  • Describe Deficiency:

  • Insert photo of deficiency, if applicable.

Conclusions

  • Amount of time spent on site during visit:

  • Were all deficiencies corrected immediately?

  • Describe deficiencies yet to be corrected and time frame for abatement:

  • Deficiency
  • Deficiency yet to be corrected:

  • Time frame for abatement:

  • Is there a need to follow up with written documentation?

  • Describe documentation needed, responsible person and time frame expected for completion.

  • Documentation Needed
  • Documentation:

  • Person Responsible:

  • Date for required completion:

  • Overall Impression of visit:

  • Comments:

  • Report Reviewed With:

  • Signature of Person Completing Audit:

  • Signature of Site Foreman

  • Signature of crew member

  • Signature of crew member

  • Signature of crew member

  • Signature of crew member

  • Additional photos

  • Additional comments

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