This audit not that

• Road Commission

• Audit Name

• Conducted on

  Date

• Contact person name and title

• Prepared by

General information

• Current mod rate

• Number of full time employees

• Number of worker comp claims in last three years

• Description of past workers comp claims

• Return to work program

• Number on facilities

Safety program

• Formal written safety program

  Yes

  No

  N/A

• Picture of safety manual table of contents

  Media

• Safety committee utilized

  Yes

  No

  N/A

• Safety committee frequency

  never

  yearly

  quarterly

  monthly

• Employee safety meeting frequency

  never

  yearly

  twice a year

  monthly

  weekly

• Formal accident investigation procedures

  Yes

  No

  N/A

• Self inspections / safety inspections performed

  Yes

  No

  N/A

• Self inspections documented

  Yes

  No

  N/A

Exterior conditions

• Condition of parking lot

  poor

  average

  above average

• Condition of walk leading into complex

  poor

  average

  above average

Main office area

• Safety Policy

  Yes

  No

  N/A

• First aid kit

  Yes

  No

  N/A

• Fire extinguishers available

  Yes

  No

  N/A

• Office rugs and runners flat

  Yes

  No

  N/A

• General Housekeeping of front office

  poor

  average

  above average

• Restrooms facilities

  poor

  average

  above average

• Record storage racks secured and stable

  Yes

  No

  N/A

• Record storage area clear

  Yes

  No

  N/A

• Office break room housekeeping

  poor

  average

  above average

Office ergonomics

• Is there ergonomics awareness training

  Yes

  No

  N/A

• Adjustable key board positions

  Yes

  No

  N/A

• Adjustable computer screen height

  Yes

  No

  N/A

• Adjustable office chairs

  Yes

  No

  N/A

PPE

• Safety glasses being used

  Yes

  No

  N/A

• Eye wash station

  Yes

  No

  N/A

• Eye wash station path accessible

  Yes

  No

  N/A

• Eye wash station clean

  Yes

  No

  N/A

• Face shield available

  Yes

  No

  N/A

• Face shield clean in good repair

  Yes

  No

  N/A

• Hearing protection available

  Yes

  No

  N/A

• Hearing protection being used

  Yes

  No

  N/A

• Proper footwear

  Yes

  No

  N/A

Hazard communications

• Responsible person identified

  Yes

  No

  N/A

• Written hazard communication plan

  Yes

  No

  N/A

• Safety Data Sheets

  Yes

  No

  N/A

• Hazard communications training

  Yes

  No

  N/A

• Containers labeled

  Yes

  No

  N/A

General conditions

• Exits marked

  Yes

  No

  N/A

• Fire extinguishers accessible

  Yes

  No

  N/A

• Fire extinguishers inspection tags up to date

  Yes

  No

  N/A

• Aisle defined

  Yes

  No

  N/A

• Aisle clear

  Yes

  No

  N/A

• Lighting adequate

  poor

  average

  above average

• General housekeeping

  poor

  average

  above average

• Rubbish contained properly

  Yes

  No

  N/A

• Used shop rags contained properly

  Yes

  No

  N/A

Hoist, lifts, overhead crane, slings, jacks and stands

• Hoist main power accessible and marked

  Yes

  No

  N/A

• Hoist hatch being used

  Yes

  No

  N/A

• Hoist controls marked

  Yes

  No

  N/A

• Hoist inspection in last 12 months

  Yes

  No

  N/A

• Overhead crane main power supply accessible and marked

  Yes

  No

  N/A

• Overhead crane inspection in last 12 months

  Yes

  No

  N/A

• Overhead crane controls marked

  Yes

  No

  N/A

• Overhead crane capacity marked

  Yes

  No

  N/A

• Slings marked with capacity and free from fray and pinch

  Yes

  No

  N/A

• Lifting hook in good repair

  Yes

  No

  N/A

• Lifting hook latch present and working

  Yes

  No

  N/A

• Jack stands available

  Yes

  No

  N/A

• Jack stand capacity marked

  Yes

  No

  N/A

Shop tools

• Bench grinder guard in place with proper adjustment

  Yes

  No

  N/A

• Extension cords grounded and free of nicks and frays

  Yes

  No

  N/A

• Drill press proper clamps

  Yes

  No

  N/A

• Drill press guards in place

  Yes

  No

  N/A

• Hand held grinders guarded

  Yes

  No

  N/A

• Hand held grinder cords free from nicks and cuts

  Yes

  No

  N/A

• Air compressor relief valve inspection tags up to date

  Yes

  No

  N/A

• Compressed air wand has pressure release holes

  Yes

  No

  N/A

Compressed gasses

• Tanks clearly labeled

  Yes

  No

  N/A

• Cylinders secured to prevent tipping

  Yes

  No

  N/A

• Cylinders segregated in hazard class and empty cylindars isolated from filled

  Yes

  No

  N/A

Notable Observations

• Add media

  Media

• Proper posters

  Yes

  No

  N/A

• Emergency contact information

  Yes

  No

  N/A

• Breakroom newsletter posted

  Yes

  No

  N/A

• Housekeeping

  poor

  average

  above average

• Sidewalk leading to employee parking

  poor

  average

  above average

• Restrooms housekeeping

  poor

  average

  above average

• Aisles clear

  Yes

  No

  N/A

• Picture of general area

  Media

• Floor clear of oil and debris

  Yes

  No

  N/A

• Tools stored properly

  Yes

  No

  N/A

• Spray bottles marked

  Yes

  No

  N/A

• Wall clear of things leaning (shovels, blades , ladders)

  Yes

  No

  N/A

• Housekeeping

  Yes

  No

  N/A

• Blade changing area hearing protection availible

  Yes

  No

  N/A

• Rags stored properly

  Yes

  No

  N/A

• Steps marked

  Yes

  No

  N/A

• Truck cab free for loose objects

  Yes

  No

  N/A

• Truck cab free for loose objects

  Yes

  No

  N/A

• Truck cab free for loose objects

  Yes

  No

  N/A

• Contact person for garage

• Garage name

• Exterior picture of garage

  Media

• Aisles clear

  Yes

  No

  N/A

• Floor clear of oil and debris

  Yes

  No

  N/A

• Tools stored properly

  Yes

  No

  N/A

• Spray bottles marked

  Yes

  No

  N/A

• Walls clear of things leaning (shovels, blades , ladders)

  Yes

  No

  N/A

• Housekeeping

  poor

  average

  above average

• Blade changing area hearing protection availible

  Yes

  No

  N/A

• Rags stored properly

  Yes

  No

  N/A

• Steps marked

  Yes

  No

  N/A

• Truck cab free for loose objects

  Yes

  No

  N/A

• Truck cab free for loose objects

  Yes

  No

  N/A

• Truck cab free for loose objects

  Yes

  No

  N/A

Project overview

• Forman in charge of operation

• Type of work

PPE

• Proper PPE used for job

  Yes

  No

  N/A

• Safety vest worn properly

  Yes

  No

  N/A

Part 6 work zone

• Work Duration

  if tred

  if erds

• Work location

  Outside of shoulder

  Shoulder

  Minor encroachment to travel portion of road

  Lane closure

  Road closure

• Advanced warning signs present

  Yes

  No

  N/A

• Advanced warning signs adequate

  Yes

  No

  N/A

• Flagged used

  Yes

  No

  N/A

• Flagged wearing proper PPE

  Yes

  No

  N/A

• Flagged in proper position

  Yes

  No

  N/A

• Emergency action discussed

  Yes

  No

  N/A

• Emergency action plan available

  Yes

  No

  N/A

Equipment

• Are flasher being used

  Yes

  No

  N/A

• Is unused equipment stored clear of hazards

  Yes

  No

  N/A

Excavation

• Has the area been marked for underground utilities

  Yes

  No

  N/A

• Are proper shoring techniques being applied

  Yes

  No

  N/A

Ground labor

• Clearly visible

  Yes

  No

  N/A

• Proper PPE for task

  Yes

  No

  N/A

Notable observations

• Add media

  Media

• Satellite mechanic shop name

PPE

• Safety glasses being used

  Yes

  No

  N/A

• Eye wash station

  Yes

  No

  N/A

• Eye wash station path accessible

  Yes

  No

  N/A

• Eye wash station clean

  Yes

  No

  N/A

• Face shield available

  Yes

  No

  N/A

• Face shield clean in good repair

  Yes

  No

  N/A

• Hearing protection availible

  Yes

  No

  N/A

• Hearing protection being used

  Yes

  No

  N/A

• Proper footwear

  Yes

  No

  N/A

Hazard communications

• Responsible person identified

  Yes

  No

  N/A

• Written hazard communication plan

  Yes

  No

  N/A

• Safety Data Sheets

  Yes

  No

  N/A

• Hazard communications training

  Yes

  No

  N/A

• Containers labeled

  Yes

  No

  N/A

General conditions

• Exits marked

  Yes

  No

  N/A

• Fire extinguishers accessible

  Yes

  No

  N/A

• Fire extinguishers inspection tags up to date

  Yes

  No

  N/A

• Aisle defined

  Yes

  No

  N/A

• Aisle clear

  Yes

  No

  N/A

• Lighting adequate

  poor

  average

  above average

• General housekeeping

  poor

  average

  above average

• Rubbish contained properly

  Yes

  No

  N/A

• Used shop rags contained properly

  Yes

  No

  N/A

Hoist, lifts, overhead crane, slings, jacks and stands

• Hoist main power accessible and marked

  Yes

  No

  N/A

• Hoist hatch being used

  Yes

  No

  N/A

• Hoist controls marked

  Yes

  No

  N/A

• Hoist inspection in last 12 months

  Yes

  No

  N/A

• Overhead crane main power supply accessible and marked

  Yes

  No

  N/A

• Overhead crane inspection in last 12 months

  Yes

  No

  N/A

• Overhead crane controls marked

  Yes

  No

  N/A

• Overhead crane capacity marked

  Yes

  No

  N/A

• Slings marked with capacity and free from fray and pinch

  Yes

  No

  N/A

• Lifting hook in good repair

  Yes

  No

  N/A

• Lifting hook latch present and working

  Yes

  No

  N/A

• Jack stands available

  Yes

  No

  N/A

• Jack stand capacity marked

  Yes

  No

  N/A

Shop tools

• Bench grinder guard in place with proper adjustment

  Yes

  No

  N/A

• Extension cords grounded and free of nicks and frays

  Yes

  No

  N/A

• Drill press proper clamps

  Yes

  No

  N/A

• Drill press gaurds in place

  Yes

  No

  N/A

• Hand held grinders guarded

  Yes

  No

  N/A

• Hand held grinder cords free from nicks and cuts

  Yes

  No

  N/A

• Air compressor relief valve inspection tags up to date

  Yes

  No

  N/A

• Compressed air wand has pressure release holes

  Yes

  No

  N/A

Compressed gasses

• Tanks clearly labeled

  Yes

  No

  N/A

• Cylinders secured to prevent tipping

  Yes

  No

  N/A

• Cylinders segregated in hazard class and empty cylindars isolated from filled

  Yes

  No

  N/A

Other notable observations

• Comments

• Pictures

  Media