Information

  • Audit Title

  • Document No.

  • Conducted on

  • Prepared by

  • Job Number

  • Location
  • Personnel

  • Job Description

  • Sunesys Region

  • In-house/Contractor

  • JSA
  • On Job-site

  • Completed as a team

  • Signed by all crew members/visitors

  • Address site hazards

  • Address safeguards

  • Vehicle/DOT
  • Unit

  • Equipment placement

  • Driver medical cards and licenses current

  • Truck cabs clean (free of empty bottles, trash, etc)

  • Lights and signals working properly

  • Vehicle logs completed

  • Vehicle Setup (cones, chocks, etc)

  • Boom Inspection completed per manufacturer requirements?

  • Trailer
  • Trailer lights working

  • Trailer brakes working

  • Safety chains properly attached

  • Electrical Protection

  • Electrical protection
  • Grounding & Clearances

  • Strand tested

  • Extension cords

  • Extension Cords
  • GFCI used?

  • Extension cords free from damage?

  • Correct style of extension cord used

  • Barrier devices and hot sticks

  • Barriers/hot sticks
  • Measuring sticks tested

  • Dielectric gloves tested

  • Glove rating appropriate for task

  • Horizontal Directional Drilling Operations

  • HDD Operations
  • Drilling rig grounded

  • Insulating gloves at operator station

  • Locator wearing insulating gloves & dielectric boots

  • Warning signs/barricades in place

  • HAZCOMM
  • SDS Sheet(s) available for all chemicals at worksite

  • Chemicals properly labelled

  • Housekeeping
  • Work area free from accumulated debris/materials

  • Fall Protection
  • Worker

  • Proper anchorage point used

  • Harness properly adjusted

  • Lanyard properly attached

  • Lanyard appropriate for height/task

  • Fall protection equipment inspected prior to use

  • Trenching & Excavation
  • Spoil piles located minimum 2 ft from edge of trench

  • Competent Person Present

  • Utilities marked

  • Shore/benching/sloping in place as required (typically begins at 5ft of depth)

  • Means of egress established for trenches over 4ft

  • PPE
  • Worker

  • Safety glasses worn (ANSI Z87)

  • PPE inspected prior to use

  • Hardhat in use

  • Hard hats within recommended operational lifetime

  • Gloves in use

  • Chaps, head/face gear used with chainsaw operations

  • Other

  • Material Handling & Rigging

  • Rigging
  • Straps, ropes, chains free from damage

  • Come-alongs not damaged. (Safety catches intact)

  • Fire Protection
  • Fire extinguisher present and has current inspection

  • Fire extinguisher charged

  • Gas can is a safety can

  • Traffic Control
  • Traffic Flow Rate

  • Work zone setup according to applicable local/state/federal guidelines

  • Flagger trained/certified as required

  • Stop/Slow paddle used

  • Red flag used for intersections only

  • First Aid/CPR
  • First Aid Kit present

  • First Aid kit properly stocked

  • Someone trained in1st Aid/CPR

  • Safe Lifting

  • Safe lifting
  • Planned the Lift

  • Keeps the load close

  • Lifts with legs

  • Avoids twisting

  • Ladder Safety
  • Ladder Inspected?

  • Proper ladder for the task<br>

  • User maintaining 3 points of contact?

  • Area around base of ladder free of debris/construction materials?

  • Confined Spaces
  • Permit completed (if applicable)

  • Access Authorized

  • Attendant Trained

  • Atmospheric Testing completed

  • Entrant Trained

  • Confined space secured

  • Special Precautions

  • Respiratory,Hearing Conservation, etc
  • Respiratory Protection

  • Hearing Conservation

  • Comments

  • Drawing

  • Photo

  • Audit Completed By

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.