The Hagerman Group

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Hagerman Foreman

SAFETY ADMINISTRATION

• All personnel have been IUCSAT verified? <br>

  Yes

  No

  N/A

• Each employee has received Hagerman safety orientation and all paperwork completed?

  Yes

  No

  N/A

• Required jobsite postings (OSHA postings, Labor Law, etc)?

  Yes

  No

  N/A

• Emergency numbers / contacts posted?

  Yes

  No

  N/A

• Emergency action plan posted / up to date?

  Yes

  No

  N/A

• An Occupational Health Clinic is set- up for injured employees and drug screens?

  Yes

  No

  N/A

• The Hagerman Group Corporate Safety & Health Manual on site?

  Yes

  No

  N/A

• MSDS on site for products being used/ 3E Poster/Decals posted?

  Yes

  No

  N/A

• Field Safety Training Completed and roster Submitted to office?

  Yes

  No

  N/A

• First aid kit onsite and adequately stocked?

  Yes

  No

  N/A

• Fire extinguishers?

  Yes

  No

  N/A

HOUSEKEEPING

• Work areas kept clean and orderly?

  Yes

  No

  N/A

• Break areas kept clean and orderly?

  Yes

  No

  N/A

• Storage areas kept clean and orderly?

  Yes

  No

  N/A

• Gas cans / cylinders stored properly with fire extinguishers present?

  Yes

  No

  N/A

• Jobsite free of slips, trips and fall hazards?

  Yes

  No

  N/A

• Jobsite signs posted (Hard hat, safety glasses, no smoking, no trespassing, etc.)?

  Yes

  No

  N/A

• Adequate lighting?

  Yes

  No

  N/A

HAND AND POWER TOOLS

• GFCI Protection being utilized?

  Yes

  No

  N/A

• Electric cords with damaged insulation, splices or missing ground pins removed from service?

  Yes

  No

  N/A

• Hand tools in good working order?

  Yes

  No

  N/A

• Handles not broke / splinter free?

  Yes

  No

  N/A

• All mechanical safeguards in use?

  Yes

  No

  N/A

• Saws have blade guard in place, and it is not disabled?

  Yes

  No

  N/A

• Mortar Mixer grill guard in place and in the down position while in operation?

  Yes

  No

  N/A

EQUIPMENT

• All Forklift Operators have been certified and trained?

  Yes

  No

  N/A

• Brakes, lights, signals, and alarms operative?

  Yes

  No

  N/A

• Seat belts worn?

  Yes

  No

  N/A

• Daily inspections filled out?

  Yes

  No

  N/A

• Aerial lift (JLG) Harnesses and lanyards being used?

  Yes

  No

  N/A

• Scissor Lift : Safety chain is in use?

  Yes

  No

  N/A

• Cranes - proper setup including distance to power lines? (20' minimum)

  Yes

  No

  N/A

• Cranes - ground conditions verified and safe for operation (underground wells, vaults, etc.)?

  Yes

  No

  N/A

• Cranes- swing radius protected - level?

  Yes

  No

  N/A

• Rigging equipment inspected - tag showing?

  Yes

  No

  N/A

LADDERS

• Ladders in good condition?

  Yes

  No

  N/A

• Proper for job and secure?

  Yes

  No

  N/A

• Placement of ladder safe?

  Yes

  No

  N/A

• Side rails extend 36 inches above landing?

  Yes

  No

  N/A

• Step ladders are open and locked in place?

  Yes

  No

  N/A

• Stair Towers being used if scaffold structures over (2) Scaffold Bucks High?

  Yes

  No

  N/A

SCAFFOLDING

• Was scaffold assembled under the supervision of a "Competent Person"?

  Yes

  No

  N/A

• Is there a scaffold tag and has it been inspected?

  Yes

  No

  N/A

• All scaffolds plumb and level?

  Yes

  No

  N/A

• Are adequate sills and base plates being used?

  Yes

  No

  N/A

• Maximum extension for screw jacks is 18 inches?

  Yes

  No

  N/A

• Work surface is is fully planked (minimum width 18 inches) and level?

  Yes

  No

  N/A

• Are scaffold planks installed past their end supports no less than 6 inches and no more than 12 inches?

  Yes

  No

  N/A

• Scaffold plank are not damaged?

  Yes

  No

  N/A

• Work side of the scaffold is no more than 14 inches away from the wall?

  Yes

  No

  N/A

• Are pigtails in place to prevent uplift?

  Yes

  No

  N/A

• Is their a safe access ladder, steps or equivalent means for safe access to the scaffold

  Yes

  No

  N/A

• Is the scaffold rated for the proper weight capacity

  Yes

  No

  N/A

• Scaffold is secured every 30 feet horizontally and 24 feet vertically against movement if taller than 4 times its base width?

  Yes

  No

  N/A

• Guardrails/protection installed on all open ends of scaffolds?<br><br>

  Yes

  No

  N/A

• Top Rail is 42 inches (+/- 3 ) with a mid rail half way in between?

  Yes

  No

  N/A

• To protect from falling objects, are toe boards installed or barricades installed?

  Yes

  No

  N/A

• Toe boards at least 3 1/2 inches in height?

  Yes

  No

  N/A

• Fall Protection on all scaffold on all scaffold above 6 feet?

  Yes

  No

  N/A

• Is the competent person performing daily scaffold inspections?

  Yes

  No

  N/A

FIRE PREVENTION

• Are hot work permits required?

  Yes

  No

  N/A

• Fire extinguishers immediately available and inspections current?

  Yes

  No

  N/A

• Propane tanks - barricade installed - labeled -( flammable,no smoking, fuel type)

  Yes

  No

  N/A

• Compressed gas cylinders secured- upright- protected from damage

  Yes

  No

  N/A

• Cutting torch (tanks secured, hoses, etc.)

  Yes

  No

  N/A

PPE

• Hard hats worn

  Yes

  No

  N/A

• Eye protection being worn and adequate for the work activity

  Yes

  No

  N/A

• Face shields being used where required

  Yes

  No

  N/A

• Welding hoods being worn in conjunction with safety glasses

  Yes

  No

  N/A

• Gloves being worn and adequate for the work activity

  Yes

  No

  N/A

• Safety harness and lanyards utilized with adequate anchorage points

  Yes

  No

  N/A

• Hearing protection

  Yes

  No

  N/A

• Respirators and masks utilized, when needed

  Yes

  No

  N/A

• High visible clothing in use by all personnel?

  Yes

  No

  N/A

MISC.

• A "Limited Access Zone" (LAZ) is in place in front of masonry wall under construction and is 4' deeper than height of wall?

  Yes

  No

  N/A

• Only Hagerman employees building the wall are allowed in the LAZ?

  Yes

  No

  N/A

• Walls over 8' are braced against collapse until supported by permanent structure?

  Yes

  No

  N/A

• Exposed rebar/bolts are covered, bent over, cut off, etc. to prevent impalement?

  Yes

  No

  N/A

SUBCONTRACTORS

• Subs wearing proper PPE

  Yes

  No

  N/A

• All subs using safe practices

  Yes

  No

  N/A

• Site Safety Inspection Report Completed By:

  Sign