TRC DOT Traffic Poles/Lights Project Safety Audit

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

General

• Is the TRC Health and Safety Plan (HASP) available onsite?

  Yes

  No

  N/A

• TRC Signage in place for site control?

  Yes

  No

  N/A

• Pre-Job Briefing/Tailboard Complete?

  Yes

  No

  N/A

• Competent Person onsite?

  Yes

  No

  N/A

• Qualified Workers?

  Yes

  No

  N/A

Personal Protective Equipment (PPE)

• Approved eye protection worn where required?

  Safe

  At Risk

  N/A

• Head protection worn where required?

  Safe

  At Risk

  N/A

• Hand protection where required?

  Safe

  At Risk

  N/A

• Reflective safety vest/clothing worn where required?

  Safe

  At Risk

  N/A

• Approved safety footwear worn where required?

  Safe

  At Risk

  N/A

• Hearing protection worn in designated areas?

  Safe

  At Risk

  N/A

• Face shield worn where required?

  Safe

  At Risk

  N/A

• Fire Resistance (FR) clothing utilized where required?

  Safe

  At Risk

  N/A

• Are respirators being worn at this work location?

  Yes

  No

  N/A

• Did workers complete pulmonary function test and fit test?

  Safe

  At Risk

  N/A

• Are respirators being worn in compliance with regulator requirements?

  Safe

  At Risk

  N/A

• Other?

  Safe

  At Risk

  N/A

Hand and Power Tools

• Are hand or power tools used at this location?

  Yes

  No

  N/A

• Visible physical damage to tool?

  Safe

  At Risk

  N/A

• Shields and guards in place?

  Safe

  At Risk

  N/A

• GFCI protection used?

  Safe

  At Risk

  N/A

• Proper use of tool?

  Safe

  At Risk

  N/A

• Certification for power actuated tool operation?

  Safe

  At Risk

  N/A

• Safety clips/pins in place on air hose connections?

  Safe

  At Risk

  N/A

• Other?

  Safe

  At Risk

  N/A

Motor Vehicle/DOT/Earth Moving Equipment

• Are motor vehicles being used at this location?

  Yes

  No

  N/A

• Seat belts properly worn?

  Safe

  At Risk

  N/A

• Are vehicles/equipment properly set up?

  Yes

  No

  N/A

• Are vehicles parked where the first move is forward where possible?

  Yes

  No

  N/A

Work Zones

• Is there traffic concerns associated with the work operation?

  Yes

  No

  N/A

• Traffic control devices appropriate for work location?

  Safe

  At Risk

  N/A

• Signage appropriate for work location?

  Safe

  At Risk

  N/A

• Are traffic cones in place?

  Safe

  At Risk

  N/A

• Are car/truck flashers on?

  Yes

  No

  N/A

• Other?

  Safe

  At Risk

  N/A

Other

• Are there other unsafe acts or conditions that need to be documented?

  Yes

  No

  N/A

• Other?

  Safe

  At Risk

  N/A

Signatures

• Supervisor

  Sign

• Auditor

  Sign