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 are needed.)
  " no" (red color) 0 points
  ( The performance failed to meet expectations, or serious violations.)
  "N/A" ( blue color)
  (If a question does not apply to the job site activities, the auditor will select N/A for "not applicable ", and 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)

  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 a 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

• Containers labeled properly?

  yes

  improve

  no

  N/A

Administration

• Are labor laws posting available in an accessible place?

  yes

  improve

  no

  N/A

• Are the safety data sheets( SDS documents) 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 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 harnesses worn correctly, with appropriate connection devices (lanyards,SRL) attached to adequate anchorage points ( able to withstand 5,000 lbs force or 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

• Are all employees ( with in 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 are put on stable ground?

  yes

  improve

  no

  N/A

• Are screw jacks in place,center on pad, and are not jacked up to 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

• Do plank extend 6" but not more than 12" over frames?

  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

• When foot plank is being used are their foot plank end rails in place (over 6 feet)?

  yes

  improve

  no

  N/A

• Have bricklayer 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 tied to structure (30' feet horizontally, 20 feet vertically to first tie and from that point 26' to second tie)?

  yes

  improve

  no

  N/A

• Are the levels the employees are working on free of debris, and can be Easley walk-through?

  yes

  improve

  no

  N/A

• Have employees made safe access to the jumps they are working on( ladders,Hewitt Systems,ect.)

  yes

  improve

  no

  N/A

• Have scaffold tags been filled out( signed and dated) ?

  yes

  improve

  no

  N/A

• Scaffolds are not fully stocked over two an 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 Oder?

  yes

  improve

  no

  N/A

• Are wire rope slings free of kinks,signs if bird caging,excessive wear,or defect ?

  yes

  improve

  no

  N/A

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

  yes

  improve

  no

  N/A

• Within one foot 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 straps in safe condition ( no tears,no visible red stripe,no UV damage)?

  yes

  improve

  no

  N/A

• Are rigging hardware and slings used correctly and within capacity?

  yes

  improve

  no

  N/A

Fire protection

• Are all flammable safety cans properly labeled?

  yes

  improve

  no

  N/A

• Are all 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 they have received documented annual inspection?

  yes

  improve

  no

  N/A

• Are all fire extinguishers in good working order (pin and tamper seal present ,good pressure,and hose free ofunobstructed?

  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 certified on the equipment they are running( forklifts,skid loader, Cranes,ect.)?

  yes

  improve

  no

  N/A

Electrical equipment (power tools)

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

  yes

  improve

  no

  N/A

• Are all 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 plugged in to GFCI protected outlets?

  yes

  improve

  no

  N/A

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

  yes

  improve

  no

  N/A

• Are electric table saws grounded by steel rod?

  yes

  improve

  no

  N/A

• Have lockout tag out been used for defective tools or extension cords?

  yes

  improve

  no

  N/A

Excavations

• If the excavation is deeper than 4' ,is it sloped or benched?

  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 for access every 25' of 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

• Has the scaffold been secured to the structure or tied down with cables at 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 there fire extinguishers located close to the heaters?

  yes

  improve

  no

  N/A

• Has lP been properly stored and protected(tied up)?

  yes

  improve

  no

  N/A

House keeping

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

  yes

  improve

  no

  N/A

• Are materials being stored properly ?

  yes

  improve

  no

  N/A

• Has used material and debris been cleaned up?

  yes

  improve

  no

  N/A