Technical Services Safety Assessment

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Weather

• Prepared by

• Location
  Address

• Personnel

Personal Protective Equiptment

• Hard hats in use by all personnel?

  Yes

  No

  N/A

• Eye protection in use by all personnel?

  Yes

  No

  N/A

• Hearing protection in use by personnel?

  Yes

  No

  N/A

• Proper foot gear worn by all personal?

  Yes

  No

  N/A

• Proper clothing worn by all personnel?

  Yes

  No

  N/A

• Reflective vest worn by all personnel?

  Yes

  No

  N/A

Tools and Equipment.

• Tools and equipment in good condition?

  Yes

  No

  N/A

• All electrical cords and cable are in good condition?

  Yes

  No

  N/A

• Electrical equipment connected properly, grounded and in good condition, GFCI, automatic magnetic cut-off for wood working tools?

  Yes

  No

  N/A

• Ladders in good condition and are proper size and safety rating?

  Yes

  No

  N/A

• Lift operator is properly trained/familiar with equipment?

  Yes

  No

  N/A

• Safety harness is worn during lifting operations?

  Yes

  No

  N/A

• Team member on the ground is designated inca self emergency lift recall/shutdown?

  Yes

  No

  N/A

Work Site

• Safety cones in good condition and placed properly?

  Yes

  No

  N/A

• Electrical noted/marked?

  Yes

  No

  N/A

• Breaks set on trucks and wheelers chocked on trucks/unhitched trailers?

  Yes

  No

  N/A

• Equipment properly secured on truck/trailer?

  Yes

  No

  N/A

• Temperature, ventilation, and lighting are adequate?

  Yes

  No

  N/A

• In comm room, were measures in place to prevent a network outage?

  Yes

  No

  N/A

• Are all comm room risk noted and preventative measures communicated to team members?

  Yes

  No

  N/A

General

• Safe access to work area?

  Yes

  No

  N/A

• Good housekeeping and material storage?

  Yes

  No

  N/A

• First aid/eye wash within 50 ft from work area?

  Yes

  No

  N/A

• Fire extinguisher in good condition, current inspection tag, within 50ft of work are?

  Yes

  No

  N/A

• Daily pre-task cards reviewed with work crews?

  Yes

  No

  N/A

D.O.T

• Truck inspection completed?

  Yes

  No

  N/A

• Lights/reflectors/beacons operational?

  Yes

  No

  N/A

• Truck cab neat/vehicle clean?

  Yes

  No

  N/A

• Tires within acceptable tread depth?

  Yes

  No

  N/A

• Trailer properly mounted/free of debris?

  Yes

  No

  N/A