Title Page

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • Select date

  • MOT/Public Exposure (Logs, Signs, Barricades, Appearance)

  • Overhead Power-lines (Permits in place, Signage Adequate, Addressed in HA, Designated Spotter in place)

  • Excavation Safety ( Log, Fall Protection, Access, Slopes, Competent Person On Site,

  • Equipment (Designated Operator, Seatbelts, Wheel Chocks, Visuals, Slow Moving Triangles, DOT Inspections, Cat Detect All workers have RFID in Hard hats )

  • Crane Safety / Engineered picks ( Rigging, Level, Off Rubber, Permits, Pads, Tag Lines, Does everyone know the weight?)

  • Fall Protection ( Anchor Point, Condition, Engineered System 100%, Open Holes)

  • Confined Space (Permit, Air Testing Monitoring, Access, Communication, Blowers)

  • Hazard Analysis (Signed, Up Dated, Pictures, W/Foremen Signature, Specific hazards addressed not blanket hazards Example - Pinch Points)

  • Housekeeping (Access, Nails in Lumber, Tripping Hazards)

  • PPE ( Safety Glasses, Gloves, Goggles, Face Shields, Back Belts, Cutting Goggles, Respirators, Tape on Boots, Chaps, Work Boots, Knee Pads)

  • Training (TBM, Designated Operator, MSDS, Orientation, Crews understand what CVIS/VTSS is)

  • Safe Operations (Impalement Hazards, Oxy/Acetylene, Safety Chains, Secured Loads, Assured Grounding, GFCI, False Work, Shoring Inspection, Ladders)

  • CVIS/VTSS ( Members designated with colored Hard hat / Vest, Meeting with Project Director every week, Notes taken, CVIS Manual Reviewed and understood by members, Photos of members posted, You asked we did board)

  • Add signature

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