Information
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Audit Title
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Document No.
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Client / Site
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Conducted on
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Prepared by:
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Location
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Personnel
- JSA
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JSA Complete?
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Does Headcount Match JSA Signatures?
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PIC on Location:
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Additional Documentation (EAP, SSSP, Inspection Checklists, & Permits):
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Emergency Action Plan (1910.38)
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Site Specific Safety Plan (1910.38)
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Equipment Inspection Checklist
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Crane Inspection Checklist
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Customer Permits
Confined Space (1926.1201)
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Confined Space
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Has the atmosphere been tested and is being monitored? <br>Oxygen (19.5% - 23.5%)<br>Lower explosive limit (LEL <1%)<br>Hydrogen Sulfide (H2S ppm <10%)<br>Carbon Monoxide (CO ppm, <1%)
Electrical Safety (1926.416)
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Electrical Safety
Equipment
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Equipment
Excavation Safety (1926.651)
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Excavation Safety
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Excavation Permits / Checklists complete?
Fall Protection (1910.21)
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Fall Protection
Fire Protection & Prevention (1926.150)
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Fire Protection & Prevention
First Aid Kit (1910.266)
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First Aid Kit
Hand and Power Tools (1910.242)
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Hand and power tools to be inspected in this audit?
Hot Work (1910.252)
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Hot Work
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Has the atmosphere been tested and is being monitored? <br>Oxygen (19.5% - 23.5%)<br>Lower explosive limit (LEL <1%)<br>Hydrogen Sulfide (H2S ppm <10%)<br>Carbon Monoxide (CO ppm, <1%)
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Fire Watch
Housekeeping (1926.25)
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Housekeeping
Ladder Safety (1910.23)
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Ladder Safety / Inspection
Lock-Out / Tag-Out (1926.417(a) & 1926.(b))
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Lock-Out / Tag-Out
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Lock-Out / Tag-Out Documentation Completed?
Material Handling (1926 Subpart H)
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Material Handling
Overhead Power Lines (1926.1410)
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Overhead Power Lines
PPE (1926.95)
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Required PPE
Restrooms & Potable Water (1926.51)
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Restrooms & Potable Water
Signs/Barricades (1926.1424)
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Signs/Barricades
Stored Materials (1926.25)
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Stored Materials
Traffic Control (1926 Subpart G)
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Traffic Control
Welding Activities (1926.351)
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Welding Activities
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Comments:
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Photos
Signatures
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Safety Signature:
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Supervisor Signature: