Title Page

  • Contractor:

  • Department:

  • Audit Date:

  • Inspector Name:

  • Location:
  • 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

  • 1. Reviewed by workers, signed (TCSR)

  • 2. Follows Work: Applicable

  • 3. Updated: being followed

  • 4. Hot Work Requirements Met: issued

  • 5. 100% tie off in use

  • 6. Leading Edges: Identified, protected

  • 7. Floor openings: permit issued, followed

  • 8. Excavation over 5ft; sloped, benched, shored

  • 9. Energy Sources: Identified, isolated, locked out

  • 10. Crane Operator Certified: Card checked

  • 11. Confined space air quality tested

  • Are all questions above compliant?

  • 12. Additional Comments for this section:

  • Add media

2. Section C1 - JSA.

  • 1. Posted, easy access

  • 2. Required documents on control board

  • 3. Additional Comments for this section:

  • Add media

3. Section D - Environment / Site Conditions.

  • 1. First Aid Kit: Stocked, Eye Wash, Accessible

  • 2. Sanitation: Toilets clean, stocked (portables)

  • 3. Noise: Below 85dba, protection used

  • 4. Lighting: General, Task

  • 5. Ventilation: Heat, Odors

  • 6. Dust Control

  • 7. Additional Comments for this section:

  • Add media

4. Section E - Personal Protective Equipment.

  • 1. Stand: Hard hat, glasses, high vis clothing, boots

  • 2. Other: Correct for area, task, department

  • 3. Additional Comments for this section:

5. Section F - Fire Protection.

  • 1. Extinguishers: Sized for task, inspected

  • 2. Flammable Liquids: Controlled, stored properly

  • 3. Additional Comments for this section:

  • Add media

6. Section G - Signs, Barricades.

  • 1. Proper Barricades: Placement

  • 2. Signs: Correct, posted, phone number, red, yellow

  • 3. Additional Comments for this section:

  • Add media

7. Section H - Materials / Handling / Storage / SS.

  • 1. Mat, Tools, Equipment: Stored properly, neatly stacked

  • 2. Trip Hazards: Cords neatly run, areas clean

  • 3. Liquids on floor: spill kit available

  • 4. Rigging for mat handling correct, stored properly

  • 5. Additional Comments for this section:

  • Add media

8. Section I - Tools: Hand and Power.

  • 1. Condition: Handles on, cord not cut

  • 2. Guarding: Used, adjusted correctly

  • 3. Proper Usage: Correct tool for the job

  • 4. Identification on gang boxes, tools, equipment

  • 5. Additional Comments for this section:

  • Add media

9. Section J - Welding, Cutting, and Grinding.

  • 1. Proper PPE: Non-flammable clothing

  • 2. Shields, Barriers: Equipment, area protected

  • 3. Gas Equipment: Proper storage, flash arrestors used

  • 4. Additional Comments for this section:

  • Add media

10. Section K - Electrical.

  • 1. GFCI Protection: tested

  • 2. Extension Cords: Condition, Protected, Inspected

  • 3. Additional Comments for this section:

  • Add media

11. Section L - Scaffolds.

  • 1. No missing planking, bracing, guardrails

  • 2. Inspected: Tagged, hazards noted

  • 3. Falling Object Protection: Toe boards

  • 4. Rolling Scaffolds: Wheels locked

  • 5. Basket: Floor cleaned, materials loaded properly

  • 6. Additional Comments for this section:

  • Add media

12. Section M - Fall Protection.

  • 1. PFRS: Inspected, good condition, worn properly

  • 2. Proper Anchorage: Clamps, Straps, Lines

  • 3. Workers tied off in scissor lifts

  • 4. Warning Lines: Used, proper distance

  • 5. Roof work: Permitted, weather conditions

  • 6. Additional Comments for this section:

  • Add media

13. Section O - Motor Vehicles / Mechanized Equipment.

  • 1. Daily inspections, equipment identified

  • 2. Safety Devices: Seat belts, lights, alarm

  • 3. Operators: Certified, authorized, licensed

  • 4. Forklift operated correctly

  • 5. Additional Comments for this section:

  • Add media

14. Section P - Excavations.

  • 1. Over 4 ft: Ladder access, every 25 ft.

  • 2. Spoils: Back 3 ft.

  • 3. Water Intrusion: Rain, seepage

  • 4. Excavation Protected: Equipment, workers

  • 5. Additional Comments for this section:

  • Add media

15. Section Q - Concrete and Masonry Construction.

  • 1. Rebar / rods capped, protected

  • 2. Masonry walls supported, limited access zone

  • 3. Additional Comments for this section:

  • Add media

16. Section R - Steel Erection, Equipment Placement.

  • 1. Area protected from overhead lifts

  • 2. Site specific erection plan in place

  • 3. Area will support equipment and load

  • 4. Additional Comments for this section:

  • Add media

17. Section T - Demolition.

  • 1. Engineer survey by Competent Person made

  • 2. All Serv: Shut off, capped, disc, removed

  • 3. Additional Comments for this section:

  • Add media

18. Section V - Power Transmission / Distribution / LO.

  • 1. Sign In/Out Sheet: Used and correct

  • 2. Group LO: Key box used / key inside

  • 3. Locks: Labeled, contain required information

  • 4. Arc Flash: Proper PPE, workers trained

  • 5. Additional Comments for this section:

  • Add media

19. Section X - Ladders.

  • 1. Secured: Used properly, right type for work

  • 2. Non-Conductive: No metal side rails

  • 3. Good Condition: rungs, rails, bracing

  • 4. Additional Comments for this section:

  • Add media

20. Section Z - Toxic / Hazardous Substances.

  • 1. Chemicals: Identified, labeled

  • 2. Stored Properly: Correct containment

  • 3. SDS Sheets: Available, correct

  • 4. Proper PPE being used

  • 5. Additional Comments for this section:

  • Add media

21. Section CC - Cranes and Derricks.

  • 1. Crane Inspection: Certifications current

  • 2. Rigging: Condition, inspected, rating tag

  • 3. Rigger Qualified: Checked

  • 4. Signal Person: Qualified, checked

  • 5. Additional Comments for this section:

  • Add media

22. Section A1 - Confined Space.

  • 1. Permit / Checklist Posted

  • 2. Workers Trained / Rescue notified

  • 3. Additional Comments for this section:

  • Add media

Signatory

  • Inspector Name and Signature:

  • Main Contractor Rep Name and Signature:

  • Main Contractor Safety Rep Name and Signature

  • Participant Name and Signature

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