Information

  • Audit Title

  • Document No.

  • Client / Site

  • Conducted on

  • Prepared by

  • Personnel

Traffic Control

  • Proper signs and placement per MUTCD

  • Posted speed limit

  • Designated flaggers

  • Do the flaggers have an escape route

  • Other

Job Site Evaluation

  • Description of job task

  • JHA performed - signed

  • Are pedestrian pathways free of tripping hazards

  • Are all holes guarded within the pedestrian pathways

  • Has the work zone been properly barricaded from the public entering the work zone

  • Housekeeping and cleanliness of job site

  • Weather

  • Temperature

  • Other

Vehicle and Equipment Evaluation

  • Authorized and qualified operator

  • Daily/ weekly/ annual inspections

  • Designated signal person

  • Seat belt used

  • Travel/ back up alarm properly working

  • Are there any significant leaks that require immediate attention

  • Other

Trailers

  • Safety chains in use

  • Condition of safety chains

  • Is the emergency brake away hooked up

  • Condition of brake away

  • Is the safety pin properly being used

  • Are wheel chocks being used

  • Other

Hand Tools and Portable Equipment Evaluation

  • Condition of hand tools

  • Proper job use

  • Is there a generator being used

  • Does the generator have a built in GFCI

  • If not is there a portable GFCI being used

  • Inspection of all cords

  • Have any cords been deemed in unsatisfactory condition for use

  • Other

Material Handling and Storage

  • Lifting chains, shackles, and lifting hooks

  • Slings

  • Have any of the above been deemed unsafe for continued on the job use

  • Flammable liquids labeled and stored properly

  • Has the lay down area been secured by means of barricades/ cones/ or caution tape

  • Other

Environmental/Emergency Response

  • First-Aid Kit

  • Spill Response Kit

  • Other

Hazardous Communication

  • MSDS Available

  • MSDS Reviewed

  • Containers Labeled Properly

Hygiene

  • Adequate Drinking Water for Employee Hydration

PPE

  • Hard Hat

  • Eye/Face

  • Hand

  • Hearing

  • Footwear

  • Hi-Vis Vest

  • Respirator

  • FRC

  • Monitors Available, In Use, Calibrated (4-Gas, H2S or Other)

  • Other:

  • Number of employees not wearing safety glasses

Hot Work

  • Permit

  • Permit Conditions Followed

  • Fire Watch

  • Gas Cylinder Management

  • Leads/Hoses/Gauges

  • Other:

Fire Protection & Prevention

  • Annual/Monthly Fire Extinguisher Inspection

  • Properly Rated/Size (BC versus ABC)

Overhead Power Lines

  • Power Lines Marked with Goal Post and Signs

  • Designated Spotter

Pressure Testing

  • Equipment Integrity

  • Whip Checks/Connections Pinned

  • Signs, Signals & Barricades

Excavation

  • Excavation Type:

  • Depth of excavation

  • Documented Inspection by Competent Person

  • Sloped Properly

  • Benched Properly

  • Trench Box/Shoring Proper - REQUIRED FOR DEPTHS OVER 5'

  • Trench Box Certifications

  • Access/Egress Points - REQUIRED FOR DEPTHS OVER 4 '

  • Spoil Pile Minimum 2-Feet From Excavation

  • Signs, Signals & Barricades

  • One Call Made

  • Utilities Identified

  • Signature of Competent Person

  • Signature of Summit Representative

General comments

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.