Information
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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
1. Working at Heights
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1.1. Fall arrest/protection system used properly (including aerial lifts)?
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1.2. Protection from openings/edges/holes?
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1.3. Guardrail systems correct?
2. Scaffolds
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2.1. Scaffolds inspected and used properly?
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2.2. Daily inspection documented/posted?
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2.3. Scissor lift (mobile scaffold) inspected before use?
3. Material Handling Equipment - Aerial Lifts
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3.1. Personnel are not exposed to overhead (suspended/elevated) loads?
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3.2. Performed daily inspections?
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3.3. Operators manual, lifting charts, informational decals available/legible?
4. Ladders
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4.1. Appropriate and undamaged ladders?
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4.2. Correct positioning/set-up of ladders?
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4.3. Ladder suitable for job?
5. Trenching/Excavation and Confined Space/PRCS
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5.1. Underground utilities located/completed O.U.P.S work order (LE S24-1)?
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5.2. Supported utilities/foundation?
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5.3. Excavation inspection prior to entry?
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5.4. Protective system (selection, installation)?
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5.5. Appropriate access/egress (vertical/horizontal)?
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5.6. Traffic control (vehicle/pedestrian)?
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5.7. Compliance with confined space entry permit (LE S-9-2)?
6. Tools / Rigging
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6.1. Hand/Power tools are operational, functional, safe and applicable guards?
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6.2. Rigging is inspected, tagged and appropriate use?
7. Personal Protective Equipment (PPE)
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7.1. Proper Use and selection of PPE?
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7.2. Issue, inspect, replace and monitor PPE?
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7.3. Training in proper use, maintenance and inspection of PPE?
8. Work Environment
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8.1. Sufficient lighting?
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8.2. Adequate housekeeping (slip, trip, fall hazards, etc.)
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8.3. Adequate noise/ vibration control?
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8.4. Exits marked and unobstructed?
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8.5. Impalement hazards protected?
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8.6. Chemicals are properly handled, used and stored?
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8.7. Fire extinguishers inspected, unobstructed and available (travel distance)?
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8.8. Potable water and cups?
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8.9. Sanitary facilities adequate and clean?
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8.10. Proper handling, use and storage of chemicals?
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8.11. Adequate traffic control plan (MUTCD)?
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8.12. Walking/working surfaces and stairs in compliance?
9. Electrical Hazards
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9.1. Safe electrical conductor?
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9.2. All outlets/tools GFCI?
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9.3. Temporary lights elevated & lamps caged?
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9.4. Energized work plan/permit used?
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9.5. All openings in cabinets or boxes covered?
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9.6. Panels covered, locked and labeled?
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9.7. Conductors secured properly?
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9.8. Temporary splices covered?
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9.9. Appropriate ARC-Flash PPE?
10. Environmental Hazards
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10.1. Clear and/or controlled rodents, insects, snakes, wild/domestic animals?
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10.2. Adequate dust suppression control?
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10.3. Adequate systems to prevent contaminants entering stormwater drains?
11. Administrative Procedures
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11.1. Adequate Pre-Task Plan?
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11.2. Obtain applicable permits (Entry, Hot, EEWP, etc)?
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11.3. Site Emergency Action Plan?
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11.4. Toolbox Talks?
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11.5. Competent, qualified, licensed personnel (1st Aid/CPR, aerial/scissor lift, confined space, powder actuated tools, mobile equipment, crane/rigging)!
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11.6. Corporate Safety Manual?
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11.7. Safety Data Sheets readily available, on site?
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11.8. State/Federal Postings?
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11.9. First Aid Kit/Eyewash?
Corrective Actions
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Enter any corrective actions that will be undertaken
Sign Off
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On site representative
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Auditor's signature
