Information
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
1.0 Working at Heights
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1.1. Daily inspection sheet filled out ?
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1.2. Guardrails, top, mid , toe ?
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1.3. Elevated work area safe, is there deficiencies ?
2.0 Bracket Scaffolds/Scaffolding
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2.1. Competent person supervisor during erection ?
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2.2. Unsafe or incomplete scaffold?
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2.3. Solid footings on scaffolding ?
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2.4. Scaffold guardrails up and sturdy, top, mid, toe ?
2.6. Other Scaffolding
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2.7. Who erected scaffold ?
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2.8. Who is scaffolding maintained by ?
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2.9. Who is to inspect scaffolding ?
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2.5. Comments
3.0 Excavation
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3.1. Excavation identified properly ?
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"Type A" means cohesive soils with an unconfined, compressive strength
of 1.5 ton per square foot (tsf) (144 kPa) or greater. Examples of
cohesive soils are: clay, silty clay, sandy clay, clay loam and, in some
cases, silty clay loam and sandy clay loam. Cemented soils such as caliche
and hardpan are also considered Type A. However, no soil is Type A if:
(i) The soil is fissured; or
(ii) The soil is subject to vibration from heavy traffic, pile driving,
or similar effects; or
(iii) The soil has been previously disturbed; or
(iv) The soil is part of a sloped, layered system where the layers dip
into the excavation on a slope of four horizontal to one vertical (4H:1V)
or greater; or
(v) The material is subject to other factors that would require it to be
classified as a less stable material.
"Type B" means:
(i) Cohesive soil with an unconfined compressive strength greater than
0.5 tsf (48 kPa) but less than 1.5 tsf (144 kPa); or
(ii) Granular cohesionless soils including: angular gravel (similar to
crushed rock), silt, silt loam, sandy loam and, in some cases, silty clay
loam and sandy clay loam.
(iii) Previously disturbed soils except those which would otherwise be
classed as Type C soil.
(iv) Soil that meets the unconfined compressive strength or cementation
requirements for Type A, but is fissured or subject to vibration; or
(v) Dry rock that is not stable; or
(vi) Material that is part of a sloped, layered system where the layers
dip into the excavation on a slope less steep than four horizontal to one
vertical (4H:1V), but only if the material would otherwise be classified
as Type B.
"Type C" means:
(i) Cohesive soil with an unconfined compressive strength of 0.5 tsf (48
kPa) or less; or
(ii) Granular soils including gravel, sand, and loamy sand; or
(iii) Submerged soil or soil from which water is freely seeping; or
(iv) Submerged rock that is not stable, or
(v) Material in a sloped, layered system where the layers dip into the
excavation or a slope of four horizontal to one vertical (4H:1V) or
steeper.
"Unconfined compressive strength" means the load per unit area at which
a soil will fail in compression. It can be determined by laboratory
testing, or estimated in the field using a pocket penetrometer, by thumb
penetration tests, and other methods.
"Wet soil" means soil that contains significantly more moisture than
moist soil, but in such a range of values that cohesive material will
slump or begin to flow when vibrated. Granular material that would exhibit
cohesive properties when moist will lose those cohesive properties when
wet. -
3.2. Soil type ?
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How was soil identified ?
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3.3. Vibrations nearby ?
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3.4. Benched and or Sloped properly ?
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3.5. Material kept 2' clear of the excavation ?
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3.6. Larger piles of material kept safe distance away from excavation?
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3.7. Water runoff issues near excavation? Cave in risk ?
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3.8. Trackhoe swing radius marked off ?
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3.9. Proper egress on excavations (every 25') ?
4.0 Fall Arrest Equipment
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4.1. Unsafe or damaged harness or equipment?
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4.2. Incompatible hooks/equipment?
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4.3. Inspected and initialed ?
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4.4. Unsafe or uncertified anchor points?
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4.5. Harnesses and components stored properly ?
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4.6. Lack of or inadequate formal training for operators?
5.0 Ladders
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5.1. Unsafe or damaged ladders?
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5.2. Unsafe positioning of ladders?
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5.3. Ladder not properly secured?
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5.4. Ladder unsuitable for job? (e.g. metal ladder used for electrical work)
6.0. Mobile Motorized Equipment
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6.1. Type of equipment on site ?
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6.2. Fire extinguisher(s) equipped and inspected ?
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6.3. Owners Manual ?
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6.4. Windshield condition ?
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6.5. Fluid Leaks ?
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6.6. Housekeeping ?
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6.7. Backup alarm ?
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Comments ?
7.0. Forklift
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7.1. Driver qualified ?
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7.2. Backup alarm ?
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Comments?
8.0. Hazcom
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8.1. Unsafe storage location? (e.g. flammables near ignition sources, spills could enter stormwater drains, etc)
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8.2. Incompatible chemicals stored near each other?
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8.3. Fire extinguisher in storage area ?
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8.4. Safety Data Sheets not accessible on site?
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8.5. Lack of emergency procedures for injury/spills/fire etc?
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8.6. Excessive quantities stored on site or in vehicles?
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8.8. Insufficient, or incorrect, PPE?
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8.9. Unsuitable/improperly labeled storage containers? (unlabeled or stored in food containers)?
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Comments ?
9. PPE
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9.1. All workers have necessary PPE ?
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9.2. PPE maintained and clean ?
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9.3. Face shields on all cutoff saws ?
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Comments ?
10.0 Work Environment
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10.1. Lack of/or inadequate amenities? (toilets, wash areas, lunch rooms, etc)
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10.2. Sufficient lighting?
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10.3. Adequate housekeeping?
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10.4. Adequate hydration for workers available ?
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10.5. Traffic controls adequate ?
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Comments ?
11.0. Electrical Hazards
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11.1. Unsafe/damaged electrical cords (frayed, cut)
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11.2. GFCI's on all electrical cords ?
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11.3. Cords free of doorways and other pinch points?
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11.4. Cords out of wet areas ?
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11.5. Power tool cords free of deficiencies?
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11.6. Electrical equipment near flammables?
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11.7. Electrical equipment near chemicals that could cause damage?
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11.8. Fire extinguisher within 25' of generators ?
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11.9. Lack of Lock-out/tag-out (LOTO) procedures for electrical equipment?
12.0 Boom/Aerial Lifts
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12.1. Fall Protection used properly ?
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12.2. Electrical on lift free of deficiencies ?
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12.3. Housekeeping on lift sufficient ?
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Comments ?
13.0 Miscellaneous
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13.1. Laser signs up if used ?
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13.3. Saw blades over worn ?
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13.4. Dangerous acts observed ?
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13.5. Impalement hazards guarded ?
Corrective Actions
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Enter any corrective actions that will be undertaken
Sign Off
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On site representative
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Auditor's signature
