1. Work Environment

  • 1.1. Lack of/or inadequate amenities? (Toilets, wash areas, lunch rooms, etc)

  • 1.2. Insufficient lighting?

2. Ladders

  • 2.1. Unsafe or damaged ladders?

  • 2.2. Unsafe positioning of ladders?

  • 2.3. Ladder extends 3' above landing?

  • 2.4. Ladder not properly secured?

  • 2.5. Ladder unsuitable for job?

3. Electrical Hazards

  • 3.1. Unsafe electrical leads? (Damaged, out of test date or untested)

  • 3.2. Contact with overhead electrical lines?

  • 3.3. Leads placed on ground or on metal structures?

  • 3.4. Electrical equipment near water?

  • 3.5. Electrical leads that may be damaged from contact with moving machinery parts?

  • 3.6. Lack of lock-out/tag-out (LOTO) procedures for electrical equipment?

4. Personal Protective Equipment (PPE)

  • 4.1. Lack of hard hats?

  • 4.2. Lack of eye protection?

  • 4.3. Lack of hard sole shoes?

  • 4.4. Lack of Sun protection?

5. Fall Protection

  • 5.1. Unsafe or damaged harness or equipment?

  • 5.2. Unsafe anchor points?

  • 5.3. Unlabeled or does not meet AS?

  • 5.4. Current employer specific fall protection plan in place?

6. Emergency Response

  • 6.1. Lack of training and rehearsal of emergency plans?

  • 6.2. Insufficient access to formally trained First Aiders for all shifts?

7. Equipment

  • 7.1. Properly trained to operate equipment?

  • 7.2. Proper loading and unloading procedures being followed?

  • 7.3. Operator in cab while load is suspended?

8. Housekeeping

  • 8.1. Clean site on and around work space area?

  • 8.2. Trash properly placed and removed from work area?

9. Tools

  • 9.1. Guard in place on tools?

  • 9.2. Tools in proper working condition?

  • 9.3. No tools damaged in use?

10. Scaffolds

  • 10.1. Filly planked?

  • 10.2. Scaffold grade lumber?

  • 10.3. Guard rails 6' (7 1/2" CA)?

  • 10.4. Base plate/mud Sills?

  • 10.5. Cross bracing?

  • 10.6. Scaffold level with screw jacks?

  • 10.7. Damaged parts?

  • 10.8. Access ladder?

Corrective Actions

  • Enter any corrective actions that will be undertaken

Sign Off

  • On site representative

  • Auditor's signature

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