Information

  • Site Name (provide job number if useful to identify site name)

  • Prepared by

  • Site Supervisor/Lead

  • Number of Employees on site

  • Conducted on

  • Location
  • List additional personnel involved with the audit.

General Conditions

  • Is the Tri-M Safety Manual available for reference?

  • If a jobsite trailer exists, are the required OSHA posters visible?

  • Are Toolbox Talk records available to demonstrate weekly meetings?

  • Is housekeeping adequate to provide a safe place to work?

  • Emergency Procedures. Is the nearest urgent care facility address known, is a first aid kit available, are incident investigation forms available, is the site emergency contact listed, is the emergency rally point provided?

  • Are fire extinguishers easily accessed, and are inspected at least monthly? Is flammable material such as containerized fuel stored in proper containers and in a safe location?

  • Provide any further comments or findings here.

Job Safety Analysis

  • Has a JSA been prepared for all affected personnel before work began?

  • Is the Work Scope section adequately completed?

  • Are job hazards adequately described and cover work scope?

  • Are Safe Work Practices and Procedures appropriate for hazards listed?

  • Are all other aspects of the JSA completed properly? If not please describe

  • Provide any further comments or findings here.

Personnel Protection

  • Is the appropriate PPE worn by all personnel? This includes at a minimum hard hats, safety glasses, work gloves appropriate for the task, and steel toe shoes?

  • What other forms of PPE are in use or needed? Please list. This may include hearing protection, respirators, flame retardant clothing or arc flash gear.

  • If additional PPE is required beyond the minimum specified above, is/are the user(s) wearing it appropriately as required?

  • Provide any further comments or findings here.

Lockout Tagout

  • Are all employees who may be exposed to hazardous energy protected by their personal lock?

  • Is the appropriate lockout form used, and is complete for all employees? Such as the Tri-M lockout log or customer equivalent.

  • Can every person on the lockout describe the steps taken to establish the lockout and verify they are safe to work?

  • Was the equipment being worked on properly tested and tried to verify absence of voltage?

  • Is the lockout work thoroughly identified on the JSA?

  • Provide any further comments or findings here.

Electrical Safety

  • Is temporary lighting guarded and hung by the lamp holder?

  • Are all tools, cords, equipment protected by an adequate GFCI system?

  • Are the proper extension cords in use, and don't have damaged insulation or missing ground plugs?

  • Are all power tools have cords without frays, no missing ground prongs, or don't have cracked casings?

  • Provide any further comments or findings here.

Fall Protection

  • If any work is conducted where there is a fall potential of 6 feet or greater (or lower than 6 feet if a customer requirement), is the appropriate fall restraint or fall arrest system in use for every affected person? Such as body harness, self retracting lanyard, and appropriate anchorage point(s).

  • If manlifts are in use, does each one have suitable railings, gates and are in good condition? Is the operator manual available on the manlift as well as an inspection checklist? Is the inspection checklist demonstrate daily inspections are being completed?

  • What type of manlift is used for elevated work?

  • If ladders are used, are they used appropriately and in good condition?

  • If scaffolds are used, do they have a current inspection tag completed by a competent person, and do they have the appropriate railings, toeboards, planking and access?

  • If a fall potential exists due to open floor areas or wall openings, are they properly barricaded to restrict access and appropriately warn of fall hazards?

  • If a job trailer is in use, does it have appropriate railings, stairs and ramps to prevent a fall risk?

  • Provide any further comments or findings here.

Confined Space

  • Is confined space work ongoing or planned?

  • Is the entry permit properly completed and available for review?

  • Is air monitoring conducted properly? For example, is continuous monitoring system established and is adequate to monitor the space, is ventilation needed and provided, are there atmospheric conditions that require monitoring beyond lack of oxygen.

  • Is an entry and rescue system set up properly and is ready for use?

  • Provide any further comments or findings here.

Excavation/Trenching

  • If the excavation is 5 or more feet deep, are the sidewalls sloped, benched or shored?

  • Is there a competent person supervising the excavation?

  • If a trench is at least 4' deep, is a stairway, ladder or ramp provided so travel is no more than 25’ in either direction to the stair, ladder or ramp?

  • Is excavated material and equipment kept 2’ from the excavation edge?

  • Provide any further comments or findings here.

Corrections Required

  • List any corrections required, or implemented during the audit, for identified deficiencies.

Comments

  • Provide any further comments here.

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.