Information
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Project/Job#
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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. Working at Heights
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1.1. Fall risks (6 ft. or more, including voids, pits, and trenches)
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1.2. Lack of edge protection?
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1.3. Unsafe or incomplete edge protection?
2. Equipment (chop saws, drills, mixers, pumps, etc.)
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2.1. Unsafe or damaged equipment? (including missing or damaged guards)
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2.2. Incorrect equipment for job? (e.g. grinding discs for cutting)
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2.3. Unsafe or incompatible attachments used with equipment?
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2.4. Unlicensed operators?
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2.5. Lack of safe work instructions?
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2.6. Lack of training in safe operation, clean-up and maintenance?
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2.7. Lack of LOTO procedures for cleaning, servicing and maintenance?
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2.8. Lack of inspection regime?
3. Scaffolds
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3.1. Uncertified persons erecting scaffold above 6 ft.?
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3.2. Unsafe or incomplete scaffold?
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3.3. Lack of inspection protocol for scaffold?
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3.4. Incompatible scaffold components? Unlabelled or do not meet SAIA standards?
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3.5. Safe Work Load (SWL) exceeded? (tools, stored materials, number of persons)
4. Lifting Equipment (scissor, boom, fork)
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4.1. Unsafe act
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4.2. Lack of daily inspection protocol?
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4.3. Unlicensed operators?
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4.4. Loads lifted over persons, close proximity to obstacles incl. overhead power lines?
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4.5. Unsafe or damaged lifting equipment, including ropes, slings, chains, hooks?
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4.6. Lifting equipment unlabelled, does not meet Manufacturers recommended standards?
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4.7. Lack of LOTO procedures for cleaning, servicing and maintenance?
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4.8. Lack of SWL information displayed?
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4.9. SWL of any lifting equipment exceeded?
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4.10. Lack of maintenance?
5. Fall Protection
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5.1. Unsafe or damaged harness or equipment?
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5.2. Incompatible hooks/equipment?
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5.3. Unlabelled or does not meet Manufacturers standards?
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5.4. Unsafe or uncertified anchor points?
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5.5. Lack of inspection protocol for equipment?
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5.6. Inadequate training for PFAS?
6. Ladders
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6.1. Unsafe or damaged ladders?
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6.2. Unsafe positioning of ladders?
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6.3. Ladder not properly secured?
7. Manual Tasks (hazardous)
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7.1. Lack of identification hazardous manual tasks?
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7.2. Lack of assessment of hazardous manual tasks?
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7.3. Inadequate risk controls? (examples: no job rotation, lighter loads, trolleys, lifting equipment, etc)
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7.4. Lack of training in risk controls and safe lifting/ team lifting techniques?
8. Hazardous Chemical (including fuel and oil)
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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. Inadequate spill containment equipment?
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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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8.7. Insufficient ventilation?
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8.8. Insufficient, or incorrect, PPE?
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8.9. Unsuitable/missing/damaged Fire protection (fire extinguisher)
9. Emergency Response
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9.1. Lack of, or no emergency plans for site?
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9.2. Emergency procedures not displayed at site?
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9.3. Lack of training and rehearsal of emergency plans?
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9.4. Lack of, or inadequate first aid kits aid equipment for site?
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9.5. Insufficient access to formally trained First Aiders for all shifts?
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9.6. Unsuitable or inadequate communication equipment?
10. Traffic Management
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10.1. Lack of, or inadequate, Traffic Management Plan (TMP) in place?
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10.2. Lack of training in TMP for all persons on site? <br>(contractors and visitors)
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10.3. Inadequate controls for TMP? (physical barriers, bollards, speed limits, flashing lights, spotters, etc)
11. Personal Protective Equipment (PPE)
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11.1. Lack of, or inadequate PPE (including sun protection)
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11.2. Lack of system to issue, inspect, replace and monitor PPE?
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11.3. Lack of training in safe use, clean-up and inspection of PPE?
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11.4. Respiratory protection/equipment?
12. Work Environment
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12.1. Inadequate housekeeping?
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12.2. Potentially Hazardous condition?
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12.3. Lack of/or inadequate amenities? (toilets, wash areas, lunch rooms, etc)
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12.4. Insufficient lighting?
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12.5. Danger area/unsafe act/horseplay?
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12.6. Lack of, or inadequate noise/ vibration control?
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12.7. Striking against-struck by/ergonomics?
13. Electrical Hazards
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13.1. Unsafe electrical leads? (damaged, out of test date or untested)
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13.2. Lack of GFCI protection?
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13.3. Contact with overhead electrical lines?
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13.4. Overloading outlets?
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13.5. Electrical equipment near water?
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13.6. Electrical equipment near flammables?
14. Environmental Hazards
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14.1. Lack of/or inadequate Environmental Management plan (EMP)?
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14.2. SWPPP
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14.3. PACM/PLCM-ACM/LCM (Asbestos/Lead)
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14.4. Lack of/or inadequate, dust suppression system?
15. Administrative Procedures
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15.1. Lack of/or inadequate Site Safety Plan?
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15.2. Lack of, or inadequate system to review SWP/IIPPas needed?
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15.3. Lack of, or inadequate, routine inspections, monitoring, audits?
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15.4. Lack of/or inadequate training, licenses, skills, experience?
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15.5. Lack of/or inadequate Job Hazard Analysis (JHA) for high- risk work?
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15.6. OSHA posters/permits/workers comp postings?
16. Fire Protection
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16.1. Fire extinguisher within proper distance of spark emitting/hot work operation?
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16.2. Fire extinguisher to code and inspected?
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16.3. Combustible gasses/flammable stored properly?
17. Confined Space
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17.1. Confined space personnel trained and certified?
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17.2. All permitted confined space controls in place?
18. Excavations
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18.1. Covers/shoring/access/sloping/etc.?
19. Misc.
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19.1. Unsafe?
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19.2. Safe?
Comments & 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 KIRK WILLIAMSON, The RAYMOND Group Director of Safety
