Information

  • Division

  • Community

  • Address

  • Installation Contractor

  • Conducted on

  • Prepared by

1. Work Environment

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

  • 1.2. Insufficient lighting?

2. Ladders

  • 2.1. Employees have been trained in proper ladder safety ?

  • 2.2. Has a ladder safety program been submitted ?

  • 2.3. Ladder extends 3' above landing?

  • 2.4. Ladder not properly secured, or is unsafely positioned ?

  • 2.5. Employees inspect ladder prior to use daily?

3. Electrical Hazards

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

  • 3.2. Contact with overhead electrical lines?

  • 3.3. All electrical work being performed is being done with the system de-energized ? If not then a specific safety plan has been developed for working on live electrical systems?

  • 3.4. Electrical equipment near water?

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

  • 3.6. Is proper lock-out/tag-out (LOTO) in use when necessary on project ?

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.Does worker have bottle of Sun protection?

5. Fall Protection

  • 5.1. Has the competent person for this specific project been identified ? Name and contact information provided ?

  • 5.2. Is the equipment inspected prior to use daily ?

  • 5.3. Has a fall protection plan been submitted? is it relevant to the wok being performed on this specific project ?

  • 5.4. Have the employees performing work been trained on fall protection

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?<br>

  • 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. Fully planked?

  • 10.2. Scaffold grade lumber?

  • 10.3. Guard rails 7 1/2" CA?

  • 10.4. Base plate/mud Sills?

  • Is the scaffolding inspected daily prior to use

  • 10.5. Cross bracing?

  • Has the competent person for this specific project been identified ? Name and contact information provided

  • 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

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.