Title Page

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • Job Scope

  • Add media

  • What type of truck is being utilized for job scope?

  • Is the JSA filled out completely/ are all hazards identified on JSA?

  • Is there an Emergency Response Plan in place and does everyone know what it is?

  • Is location, trucks and work areas clean and organized?

  • Is proper PPE utilized for the job scope?

  • Is PPE worn correctly?

  • FR clothing worn and in good condition?

  • Are gas monitors turned on and worn correctly?

  • Are fire extinguishers in good condition, fully charged and current on inspections

  • Are hand tools in compliance?

  • Are power tools in compliance?

  • Are extension cords in compliance?

  • Is any heavy equipment being used? if so is the operator trained and certified, has a daily equipment inspection been conducted and is the equipment being used correctly?

  • Is any work being conducted that requires fall protection? If so is the equipment in compliance, is the worker trained and is the condition safe?

  • Is any confined space work being conducted? If so is a permit filled out if required, is everyone conducting the work trained and is the condition safe?

  • Is any lifting or hoisting operations taking place? If so is all lifting equipment in compliance, are all workers trained and are taglines and a spotter being utilized?

  • Is any excavation work being conducted? If so is everyone trained and is the condition safe?

  • Is LOTO being conducted? if so is a lockout plan filled out, is everyone trained and is the condition safe?

  • Is a SDS binder available?

  • Is a first aid kit, bloodborne pathogens kit and eye wash station available and stocked?

  • Is drinking water available?

  • Was three point contact maintained anytime the truck was boarded or exited?

  • Is there equipment for roadside assistance and or awareness?

  • Is a hazard identified?

  • Any concerns or needs?

  • Add signature

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