Site Safety Audit

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by:

• Location
  Address

• Personnel

JSA

• JSA Complete?

  Yes

  No

  N/A

• Does Headcount Match JSA Signatures?

• PIC on Location:

• Additional Documentation (EAP, SSSP, Inspection Checklists, & Permits):

• Emergency Action Plan (1910.38)

  Yes

  No

  N/A

• Site Specific Safety Plan (1910.38)

  Yes

  No

  N/A

• Equipment Inspection Checklist

  Yes

  No

  N/A

• Crane Inspection Checklist

  Yes

  No

  N/A

• Customer Permits

  Yes

  No

  N/A
Confined Space (1926.1201)

• Confined Space

  Safe

  At Risk

  N/A

• 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%)

  Yes

  No

  N/A
Electrical Safety (1926.416)

• Electrical Safety

  Safe

  At Risk

  N/A
Equipment

• Equipment

  Safe

  At Risk

  N/A
Excavation Safety (1926.651)

• Excavation Safety

  Safe

  At Risk

  N/A

• Excavation Permits / Checklists complete?

  Yes

  No

  N/A
Fall Protection (1910.21)

• Fall Protection

  Safe

  At Risk

  N/A
Fire Protection & Prevention (1926.150)

• Fire Protection & Prevention

  Safe

  At Risk

  N/A
First Aid Kit (1910.266)

• First Aid Kit

  Safe

  At Risk

  N/A
Hand and Power Tools (1910.242)

• Hand and power tools to be inspected in this audit?

  Safe

  At Risk

  N/A
Hot Work (1910.252)

• Hot Work

  Safe

  At Risk

  N/A

• 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%)

  Yes

  No

  N/A

• Fire Watch

  Yes

  No

  N/A
Housekeeping (1926.25)

• Housekeeping

  Safe

  At Risk

  N/A
Ladder Safety (1910.23)

• Ladder Safety / Inspection

  Safe

  At Risk

  N/A
Lock-Out / Tag-Out (1926.417(a) & 1926.(b))

• Lock-Out / Tag-Out

  Safe

  At Risk

  N/A

• Lock-Out / Tag-Out Documentation Completed?

  Yes

  No

  N/A
Material Handling (1926 Subpart H)

• Material Handling

  Safe

  At Risk

  N/A
Overhead Power Lines (1926.1410)

• Overhead Power Lines

  Safe

  At Risk

  N/A
PPE (1926.95)

• Required PPE

  Safe

  At Risk

  N/A
Restrooms & Potable Water (1926.51)

• Restrooms & Potable Water

  Safe

  At Risk

  N/A
Signs/Barricades (1926.1424)

• Signs/Barricades

  Safe

  At Risk

  N/A
Stored Materials (1926.25)

• Stored Materials

  Safe

  At Risk

  N/A
Traffic Control (1926 Subpart G)

• Traffic Control

  Safe

  At Risk

  N/A
Welding Activities (1926.351)

• Welding Activities

  Safe

  At Risk

  N/A

• Comments:

• Photos

  Media

Signatures

• Safety Signature:

  Sign

• Supervisor Signature:

  Sign