SMI

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Overview job pictures

  Media

• Performance rating:10 being the best( little to no risk), and 1 being worst( high risk for injuries or fines)

• General audit comments

Explanation of audit scoring

• "Yes" (green color) - 2 points
  (The job site performance met or exceeded expectations for this specific audit question)
  
  "Improve" (yellow color) - 1 point
  (The performance generally met expectations, but some specific improvements were needed)
  
  "No" (red color) - 0 points
  (The performance failed to meet expectations, or serious violations were addressed)
  
  "N/A" ( blue color)
  (If a question does not apply to job site activities, the auditor will select "N/A" for "not applicable". No score will be added or subtracted from the audit.

P.P.E.

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

  yes

  improve

  no

  N/A

• Are safety glasses worn 100% of the time?

  yes

  improve

  no

  N/A

• Are employees wearing appropriate safety glasses for their environment? ( no sunglasses in dark areas ,no fogging,no defects)?

  yes

  improve

  no

  N/A

• Have face shields been selected for appropriate hazards? ( grinding,drilling overhead, flying debris)

  yes

  improve

  no

  N/A

• Is Hearing protection being used while sawing inside or on a table saw?

  yes

  improve

  no

  N/A

• Is eyewash in an accessible area and properly set up?

  yes

  improve

  no

  N/A

• Respirators- if used, are they being used properly?

  yes

  improve

  no

  N/A

• Are gloves and safety glasses being worn during wash down?

  yes

  improve

  no

  N/A

• If required by job site, are all employees wearing high visibility clothing?

  yes

  improve

  no

  N/A

• Are employees wearing work boots that comply with SMI?

  yes

  improve

  no

  N/A

• Are employees wearing shirts with four inch sleeves? (No cut offs)

  yes

  improve

  no

  N/A

HazCom

• HazCom notebook present?

  yes

  improve

  no

  N/A

• HazCom checklist present ?

  yes

  improve

  no

  N/A

• Are containers labeled properly? Are labels legible?

  yes

  improve

  no

  N/A

Administration

• Are labor law postings available in an accessible place?

  yes

  improve

  no

  N/A

• Are the Material Safety Data Sheets (MSDS) and/or Safety Data Sheets (SDS) on site for every potential chemical exposure?

  yes

  improve

  no

  N/A

• Has a site safety plan been developed and followed?

  yes

  improve

  no

  N/A

• Are morning huddles being conducted?

  yes

  improve

  no

  N/A

• Have all employees participated in morning stretches?

  yes

  improve

  no

  N/A

• Is the Emergency Medical Card posted?

  yes

  improve

  no

  N/A

• Is an approved First Aid Kit present?

  yes

  improve

  no

  N/A

Fall protection

• Is the fall arrest equipment in good working order (fully functional, no defects, or damage)?

  yes

  improve

  no

  N/A

• Are PFAS being worn correctly? - This includes a full body harness, an appropriate connection device (lanyard/SRL), and an adequate anchorage point (able to withstand at least 5,000 lbs force or have an engineered safety factor of two times the potential force of the fall).

  yes

  improve

  no

  N/A

• Have all affected employees been trained on the proper use of personal fall protection systems?

  yes

  improve

  no

  N/A

• Has a Fall Rescue Plan been put in place and discussed with the crew? <br>(Ex. If a crew member falls while using a PFAS and is knocked unconscious, how will we retrieve the individual safely?)

  yes

  improve

  no

  N/A

• Are all employees ( within 15' of leading edge) protected by personal fall arrest system or guard rail systems?

  yes

  improve

  no

  N/A

• If SMI employees are working from the leading edge have they put up a control access zone 15' feet from the edge? <br>To keep unauthorized people out?<br>

  yes

  improve

  no

  N/A

Scaffolds

• Are scaffolds built level and plumb?

  yes

  improve

  no

  N/A

• Are mud sills (pads) in place, level, and on stable ground?

  yes

  improve

  no

  N/A

• Are screw jacks in place, centered on pad, and not jacked up too high?

  yes

  improve

  no

  N/A

• Have all braces been put in place?

  yes

  improve

  no

  N/A

• Are scaffolds fully planked ( where employees are working)?

  yes

  improve

  no

  N/A

• Are the scaffold plank in good condition? Are employees removing defective plank from service?

  Yes

  No

  N/A

• Do plank extend 6" but not more than 12" over frames? If not, are employees cleating plank to secure them from displacement?

  yes

  improve

  no

  N/A

• Are all guard rails and end rails in place (6' tall or higher) if employees are working from or accessing the jump?

  yes

  improve

  no

  N/A

• Have all toe boards been installed on all decks with material on them?

  yes

  improve

  no

  N/A

• Are the mason's foot plank end rails in place (over 6 feet)?

  yes

  improve

  no

  N/A

• Has a bricklayer's foot plank access been put in place (when needed)?

  yes

  improve

  no

  N/A

• Are scaffolds erected no higher than four times the minimum base width?

  yes

  improve

  no

  N/A

• Are scaffolds braced, guyed, or tied to the structure properly? (At least every 30ft horizontally, 20ft vertically, and 26ft thereafter)

  yes

  improve

  no

  N/A

• Are the scaffold platforms that employees are working on easily accessible? (Free of debris, trash, trip hazards, etc..)

  yes

  improve

  no

  N/A

• Have employees made safe access to the scaffold access, and the jumps they are working on? (Ladders, Hewitt Systems, etc...)

  yes

  improve

  no

  N/A

• Are scaffold tags being filled out properly? (Signed and dated by competent person)

  yes

  improve

  no

  N/A

• Are scaffold tags being removed from placards when scaffold is incomplete and/or at the end of each shift?

  yes

  improve

  no

  N/A

• Are scaffolds not fully stocked over two and a half jumps ahead?

  yes

  improve

  no

  N/A

• Does the scaffold have pig tails in?

  yes

  improve

  no

  N/A

Rigging

• Are rigging shackles, hooks, and lifting accessories operating freely and in good working order?

  yes

  improve

  no

  N/A

• Are wire rope slings free of kinks, signs of bird caging, excessive wear, or any other defects?

  yes

  improve

  no

  N/A

• In one lay, are there less than 3 broken wires in 1 strand?

  yes

  improve

  no

  N/A

• Within 1ft from the eye on a wire rope, are there less than 2 broken wires in 1 strand ?

  yes

  improve

  no

  N/A

• Are tags present on all slings that list manufacturer and recommended safe working load?

  yes

  improve

  no

  N/A

• Are synthetic/nylon straps in good condition? (No tears/cuts/frays, no visible red string, no UV and/or chemical damage)

  yes

  improve

  no

  N/A

• Are all rigging components and/or slings used correctly and within lifting capacity?

  yes

  improve

  no

  N/A

Fire Protection

• Are all flammable safety cans properly labeled?

  yes

  improve

  no

  N/A

• Are fire extinguishers posted near all flammable storage areas and hot work zones?

  yes

  improve

  no

  N/A

• Do all fire extinguishers have a tag demonstrating that they have received documented annual inspections? Are employees inspecting fire extinguishers frequently?

  yes

  improve

  no

  N/A

• Are all fire extinguishers in good working order? (Pin and tamper seal are present, good pressure, extinguisher hose free of obstruction)

  yes

  improve

  no

  N/A

Power Machinery

• Are all documented inspections completed before each use?

  yes

  improve

  no

  N/A

• Are all pieces of powered equipment operating well without leaks or obvious signs of physical defects?

  yes

  improve

  no

  N/A

• Are all attachments secured from movement?

  yes

  improve

  no

  N/A

• Are all equipment operators trained and/or certified on the equipment they are operating? (Forklifts, skid loaders, cranes, etc..)

  yes

  improve

  no

  N/A

Electrical Equipment (power tools)

• Have assured grounding tests been conducted on tools and extension cords in use? (correct quarterly color)

  yes

  improve

  no

  N/A

• Are all power tool and extension cords in good condition?

  yes

  improve

  no

  N/A

• Are all manufacturer recommended guards properly mounted and used?

  yes

  improve

  no

  N/A

• Are extension cords GFCI protected?

  yes

  improve

  no

  N/A

• Are cords not strung out in walk ways or being run over by equipment?

  yes

  improve

  no

  N/A

• Are electric table saws properly grounded?

  yes

  improve

  no

  N/A

• Has our lock out tag out policy been used for defective tools or extension cords?

  yes

  improve

  no

  N/A

Excavations

• If the excavation is deeper than 4 ft, is it properly sloped or benched back?

  yes

  improve

  no

  N/A

• Is the spoil pile at least 2' from the edge of the excavation?<br>

  yes

  improve

  no

  N/A

• Is there a ladder or ramp access for every 25' around the trench?

  yes

  improve

  no

  N/A

• Has equipment been barricaded from excavation?

  yes

  improve

  no

  N/A

Winter Enclosures

• Does the plastic appear to be installed correctly? (no loose plastic the wind can get ahold of)

  yes

  improve

  no

  N/A

• Is the scaffold secured to the structure, or tied down with cables every 15' horizontally and 13' vertically ?

  yes

  improve

  no

  N/A

• Are approved heaters being used?

  yes

  improve

  no

  N/A

• Are heaters being properly ventilated in the shelter?

  yes

  improve

  no

  N/A

• Are fire extinguishers located close to the heaters?

  yes

  improve

  no

  N/A

• Has lP been properly stored and protected? (Secured from tip over or tied to stable structure)

  yes

  improve

  no

  N/A

Housekeeping

• Is equipment being cleaned? (mixers, tubs, shovels, etc...)

  yes

  improve

  no

  N/A

• Are materials being stored properly?

  yes

  improve

  no

  N/A

• Has used material and/or debris been properly disposed of?

  yes

  improve

  no

  N/A