STA

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Job Site Name:
  Address

Date:

Project Manager:

Foreman:

Employee (s) Onsite:

Task location (i.e roof, first floor etc.)

• Permits

  Other

• Was anyone or did an unplanned incident occur today.

  Yes

  No

  N/A

• Was it reported to the Safety Manager.

  Yes

  No

  N/A

• Did you have any problems with today's work.

  Yes

  No

  N/A

• Add media

  Media

• Personal Protective Equipment Required

  Full Body Harness

  Retractable Lanyard

  Warning Line

  Eye Protection

  Hard Hats

• Additional Personal Protective Equipment Required:

• Are there any certifications required.

  Yes

  No

  N/A

• Was your safety set up an in compliance with all OSHA standards.

  Yes

  No

  N/A

• What are your safety systems in place.

  Yes

  No

  N/A

• Add media

  Media

• Do you have any miscellaneous concerns.

  Yes

  No

  N/A

• Add media

  Media

• Foreman Signature

  Sign