Steep Slope Roofing

• (Revision 06-2013)

• Name and Address of Project
  Address

• Name of Team Leader

• # of Employees

• Date Audit Performed

  Date

• Prepared by

Fall Protection

• Fall Protection Required

  Yes

  No

  N/A

• Parapet Wall 39 inches or above. (Max 30 Points)

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  Media

• Guard Rail

  Yes

  No

  N/A

• Guard Rail (Max 26 Points)

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  Media

• Top Rail, 42 inches (+ / - 3) above working surface.

  Yes

  No

  N/A

• Mid Rail, 21 inches (+ / - 3) above working surface.

  Yes

  No

  N/A

• Toe-board for work above 10 ft.

  Yes

  No

  N/A

• Fall Arrest or Restraint (Max 24 Points)

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• Rope Inspected

  Yes

  No

  N/A

• Harness Inspected

  Yes

  No

  N/A

• Lanyard Inspected

  Yes

  No

  N/A

• Anchor Installed as required by Manufacturer, PE, or Qualified Person.

  Yes

  No

  N/A

• Warning Line (Max 20 Points)

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• 34 - 39 Inches Above Working Surface.

  Yes

  No

  N/A

• Flagging Every 6 Ft.

  Yes

  No

  N/A

• Stands can Withstand 16 lbs. of Tipping Force.

  Yes

  No

  N/A

• Rope is Stronger than 500 lbs. Tensile Strength.

  Yes

  No

  N/A

• Warning Line 6 - 10 Feet Away from Fall Hazards.

  Yes

  No

  N/A

• Fall Arrest, Fall Restraint, or Safety Monitor Used for Work Outside Warning Line.

  Yes

  No

  N/A

• Safety Monitor (Max 15 Points)

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• On Same Level as Work.

  Yes

  No

  N/A

• Can Communicate with Exposed Employees.

  Yes

  No

  N/A

• Is not Distracted by Other Duties.

  Yes

  No

  N/A

• Has been Trained and is Authorized to Stop Unsafe Work or Behaviors.

  Yes

  No

  N/A

• Has on High Visibility Vest.

  Yes

  No

  N/A

• Monitors behind Warning Line & Communicates with Employees.

  Yes

  No

  N/A

Ladder Set-up

• Fixed Stairs

  Yes

  No

  N/A

• Fixed Stair Max (20 points)

• Fixed Ladder

  Yes

  No

  N/A

• Fixed Ladder

• Secured to Wall or Structure

  Yes

  No

  N/A

• Safe to Climb

  Yes

  No

  N/A

• Extension Ladder Used

  Yes

  No

  N/A

• Extension Ladder (16 Max Points)

• Has inspection tag.

  Yes

  No

  N/A

• Missing, bent, or broken parts

  Yes

  No

  N/A

• Missing fly rope.

  Safe

  At Risk

  N/A

• 3 ft. above landing or eave.

  Safe

  At Risk

  N/A

• Secured at top.

  Safe

  At Risk

  N/A

• Secured at bottom.

  Safe

  At Risk

  N/A

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PPE

• Hearing Protection Required for Loud Noises.

  Yes

  No

  N/A

• Hard Hat worn for overhead hazards and work.

  Yes

  No

  N/A

• Longs Pants Required for Hot Work

  Yes

  No

  N/A

• Long Sleeved Shirt Required for Hot Work

  Yes

  No

  N/A

• Respirator Required.

  Yes

  No

  N/A

• Safety Glasses

  Yes

  No

  N/A

• Worn for tear off.

  Yes

  No

  N/A

• Worn for other eye hazards.

  Yes

  No

  N/A

• PPE worn correctly.

  Yes

  No

  N/A

• Wrong PPE for Protection.

  Yes

  No

  N/A

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• PPE (10 Points Max)

Electrical

• Wires inspected.

  Yes

  No

  N/A

• GFCI Used for Temporary Power Sources.

  Yes

  No

  N/A

• Work Remains 20 feet Away from Electrical Lines

  Yes

  No

  N/A

• Covers Required for Electrical Lines.

  Yes

  No

  N/A

• Does Power Need to be Removed or Turned Off

  Yes

  No

  N/A

• Electrical (10 Points Max)

Material Hoisting

• Nails Bent or Removed from Boards.

  Yes

  No

  N/A

• Trash Chute or Hoisting Used for Elevated Projects (20 feet or more)

  Yes

  No

  N/A

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• Overhead Work Signs Posted.

  Yes

  No

  N/A

• Pallets Not Stacked More than 2 High

  Yes

  No

  N/A

• Hoisting

  Yes

  No

  N/A

• Forklift Operator Trained.

  Yes

  No

  N/A

• Rigger Trained and Communicates with Operator.

  Yes

  No

  N/A

• Signal Person Trained and Communicates with Operator.

  Yes

  No

  N/A

• Crane Operator Trained.

  Yes

  No

  N/A

• Daily Inspection Performed.

  Yes

  No

  N/A

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• Rigging Equipment and Materials are Serviceable for Operations.

  Yes

  No

  N/A

• Signal Person Trained and Communicates with Operator.

  Yes

  No

  N/A

• Flagging or Warning Lines Around Crane and Lift Area.

  Yes

  No

  N/A

• Taglines Used for Material or Equipment Control.

  Yes

  No

  N/A

• Hoisting (5 Points Max)

General Liability

• Roof Tie-in Performed Daily.

  Yes

  No

  N/A

• Plugs Removed from Drains.

  Yes

  No

  N/A

• Work logged Daily in a Journal.

  Yes

  No

  N/A

• Site or Project Inspected for Previous Damage.

  Yes

  No

  N/A

• Caution Signs Posted.

  Yes

  No

  N/A

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• General Liability (5 Points Max)

Fire Prevention

• Extinguishers within 25 - 50 feet of Work.

  Yes

  No

  N/A

• Used / Spent Extinguishers removed from Project or Site.

  Yes

  No

  N/A

• Gas Cans Labeled and Stored.

  Yes

  No

  N/A

• Screen Located Within Gas Cans.

  Yes

  No

  N/A

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• Fire Prevention (10 Points Max)

Emergency Readiness

• First Aid Kit (with Eye Wash Bottle) On-Site and Available to Employees.

  Yes

  No

  N/A

• HAZCOM Manual On-Site and Available to Employees.

  Yes

  No

  N/A

• Safety Manual On-Site and Available to Employees.

  Yes

  No

  N/A

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• Emergency Readiness

Scaffold.

• Scaffold Required

  Yes

  No

  N/A

• Scaffold has Hoist for Materials.

  Yes

  No

  N/A

• Access Secured at Night.

  Yes

  No

  N/A

• Inspected by Competent Person.

  Yes

  No

  N/A

• Scaffold has Green Tag for Use.

  Yes

  No

  N/A

• Scaffold is level.

  Yes

  No

  N/A

• 4:1 Ratio and Tied to Building (Push / Pull)

  Yes

  No

  N/A

• Walk Boards Bent.

  Yes

  No

  N/A

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  Media

• Scaffold (5 Points Max)

Safety Talks

• Performed Weekly, Signed & Turned In

  Yes

  No

  N/A

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