Title Page
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Document No.
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Audit Title
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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
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Job Scope
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What type of truck is being utilized for job scope?
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Is the JSA filled out completely/ are all hazards identified on JSA?
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Is there an Emergency Response Plan in place and does everyone know what it is?
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Is location, trucks and work areas clean and organized?
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Is proper PPE utilized for the job scope?
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Is PPE worn correctly?
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FR clothing worn and in good condition?
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Are gas monitors turned on and worn correctly?
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Are fire extinguishers in good condition, fully charged and current on inspections
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Are hand tools in compliance?
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Are power tools in compliance?
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Are extension cords in compliance?
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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?
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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?
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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?
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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?
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Is any excavation work being conducted? If so is everyone trained and is the condition safe?
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Is LOTO being conducted? if so is a lockout plan filled out, is everyone trained and is the condition safe?
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Is a SDS binder available?
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Is a first aid kit, bloodborne pathogens kit and eye wash station available and stocked?
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Is drinking water available?
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Was three point contact maintained anytime the truck was boarded or exited?
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Is there equipment for roadside assistance and or awareness?
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Is a hazard identified?
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Any concerns or needs?
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