Title Page
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Contractor:
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Department:
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Audit Date:
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Inspector Name:
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Location:
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INSTRUCTIONS
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1. Please answer "Yes," "No," or "N/A" on the questions below.
2. Add photos and notes by clicking on the paperclip icon
3. To add a Corrective Action click on the paperclip icon then "Add Action," provide a description, assign to a member, set priority, and due date
4. Complete audit by providing digital signature
5. Share your report by exporting as PDF, Word, Excel or Web Link
1. Section C - Major
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1. Reviewed by workers, signed (TCSR)
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2. Follows Work: Applicable
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3. Updated: being followed
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4. Hot Work Requirements Met: issued
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5. 100% tie off in use
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6. Leading Edges: Identified, protected
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7. Floor openings: permit issued, followed
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8. Excavation over 5ft; sloped, benched, shored
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9. Energy Sources: Identified, isolated, locked out
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10. Crane Operator Certified: Card checked
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11. Confined space air quality tested
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Are all questions above compliant?
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12. Additional Comments for this section:
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2. Section C1 - JSA.
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1. Posted, easy access
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2. Required documents on control board
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3. Additional Comments for this section:
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3. Section D - Environment / Site Conditions.
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1. First Aid Kit: Stocked, Eye Wash, Accessible
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2. Sanitation: Toilets clean, stocked (portables)
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3. Noise: Below 85dba, protection used
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4. Lighting: General, Task
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5. Ventilation: Heat, Odors
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6. Dust Control
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7. Additional Comments for this section:
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4. Section E - Personal Protective Equipment.
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1. Stand: Hard hat, glasses, high vis clothing, boots
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2. Other: Correct for area, task, department
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3. Additional Comments for this section:
5. Section F - Fire Protection.
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1. Extinguishers: Sized for task, inspected
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2. Flammable Liquids: Controlled, stored properly
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3. Additional Comments for this section:
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6. Section G - Signs, Barricades.
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1. Proper Barricades: Placement
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2. Signs: Correct, posted, phone number, red, yellow
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3. Additional Comments for this section:
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7. Section H - Materials / Handling / Storage / SS.
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1. Mat, Tools, Equipment: Stored properly, neatly stacked
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2. Trip Hazards: Cords neatly run, areas clean
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3. Liquids on floor: spill kit available
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4. Rigging for mat handling correct, stored properly
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5. Additional Comments for this section:
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8. Section I - Tools: Hand and Power.
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1. Condition: Handles on, cord not cut
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2. Guarding: Used, adjusted correctly
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3. Proper Usage: Correct tool for the job
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4. Identification on gang boxes, tools, equipment
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5. Additional Comments for this section:
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9. Section J - Welding, Cutting, and Grinding.
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1. Proper PPE: Non-flammable clothing
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2. Shields, Barriers: Equipment, area protected
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3. Gas Equipment: Proper storage, flash arrestors used
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4. Additional Comments for this section:
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10. Section K - Electrical.
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1. GFCI Protection: tested
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2. Extension Cords: Condition, Protected, Inspected
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3. Additional Comments for this section:
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11. Section L - Scaffolds.
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1. No missing planking, bracing, guardrails
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2. Inspected: Tagged, hazards noted
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3. Falling Object Protection: Toe boards
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4. Rolling Scaffolds: Wheels locked
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5. Basket: Floor cleaned, materials loaded properly
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6. Additional Comments for this section:
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12. Section M - Fall Protection.
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1. PFRS: Inspected, good condition, worn properly
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2. Proper Anchorage: Clamps, Straps, Lines
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3. Workers tied off in scissor lifts
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4. Warning Lines: Used, proper distance
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5. Roof work: Permitted, weather conditions
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6. Additional Comments for this section:
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13. Section O - Motor Vehicles / Mechanized Equipment.
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1. Daily inspections, equipment identified
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2. Safety Devices: Seat belts, lights, alarm
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3. Operators: Certified, authorized, licensed
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4. Forklift operated correctly
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5. Additional Comments for this section:
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14. Section P - Excavations.
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1. Over 4 ft: Ladder access, every 25 ft.
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2. Spoils: Back 3 ft.
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3. Water Intrusion: Rain, seepage
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4. Excavation Protected: Equipment, workers
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5. Additional Comments for this section:
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15. Section Q - Concrete and Masonry Construction.
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1. Rebar / rods capped, protected
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2. Masonry walls supported, limited access zone
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3. Additional Comments for this section:
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16. Section R - Steel Erection, Equipment Placement.
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1. Area protected from overhead lifts
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2. Site specific erection plan in place
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3. Area will support equipment and load
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4. Additional Comments for this section:
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17. Section T - Demolition.
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1. Engineer survey by Competent Person made
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2. All Serv: Shut off, capped, disc, removed
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3. Additional Comments for this section:
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18. Section V - Power Transmission / Distribution / LO.
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1. Sign In/Out Sheet: Used and correct
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2. Group LO: Key box used / key inside
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3. Locks: Labeled, contain required information
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4. Arc Flash: Proper PPE, workers trained
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5. Additional Comments for this section:
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19. Section X - Ladders.
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1. Secured: Used properly, right type for work
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2. Non-Conductive: No metal side rails
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3. Good Condition: rungs, rails, bracing
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4. Additional Comments for this section:
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20. Section Z - Toxic / Hazardous Substances.
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1. Chemicals: Identified, labeled
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2. Stored Properly: Correct containment
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3. SDS Sheets: Available, correct
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4. Proper PPE being used
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5. Additional Comments for this section:
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21. Section CC - Cranes and Derricks.
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1. Crane Inspection: Certifications current
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2. Rigging: Condition, inspected, rating tag
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3. Rigger Qualified: Checked
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4. Signal Person: Qualified, checked
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5. Additional Comments for this section:
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22. Section A1 - Confined Space.
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1. Permit / Checklist Posted
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2. Workers Trained / Rescue notified
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3. Additional Comments for this section:
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Signatory
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Inspector Name and Signature:
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Main Contractor Rep Name and Signature:
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Main Contractor Safety Rep Name and Signature
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Participant Name and Signature
