Information

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • Before leaving for the job site, check the following:

STOP/SLOW Paddle

  • Clean

  • Sign at least 18" x 18"?

  • Rigid Handle at least 5 ft. High.

  • Retroreflective if used at night

Flag

  • Good Grade Red/Orange Material?

  • Flag at least 18" x 18"?

  • Staff at least 3 ft. Long?

  • Retroreflective if used at night?

  • Weighted?

  • Used for Emergencies Only?

High-Visibility Safety Apparel

  • ANSI Class 2 apparel for daytime work?

  • ANSI Class 3 apparel for nighttime work?

  • Proper Colors?

  • Clean?

  • Hard Hat?

  • Does it protect you from the elements?

Communication Devices

  • Two-Way Radio?

  • Flag for token method?

  • Extra Batteries?

Other

  • Air Horn?

  • Whistle?

  • Water?

  • Snacks?

  • Pencil and Paper?

  • Comfortable shoes?

  • Sun protection?

  • Gloves?

  • Bug spray?

  • First-Aid Kit

  • Flagger Handbook?

  • Have you asked your Supervisor all your questions?

  • Do you have a way of contacting your Supervosor?

  • Have you received the proper training to perform this job?

At the job site, before starting the flagging operation, if applicable:

  • Are you wearing your at least ANSI 107 Class 2 high-visibility safety apparel and hard hat?

  • Is your Air Horn easily accessible?

  • Have you told your fellow workers how you plan to warn them?

  • Is there at least a FLAGGER AHEAD sign ahead of you?

  • If in rural area, is the sign at least 500 feet ahead of you?

  • Can you effectively communicate with the other flagger(s)?

  • Is your radio working properly?

  • Are you clearly visible to oncoming traffic?

  • Are you on the shoulder and away from moving traffic?

  • Are you giving the proper signals to oncoming drivers?

  • STOP

  • RELEASE

  • SLOW

  • Have you expressed any concerns to your Supervisor?

  • Have you identified your escape route?

  • Are there a transition (taper) and a buffer space between you and the work space?

  • Proper devices (such as cones).

  • Taper should be no longer than 100 feet long.

  • Buffer should be between 200 and 500 feet (check with the supervisor).

  • Do not leave your post.

In case of a violation:

  • Protect yourself FIRST!

  • Alert other workers (air horn).

  • Maintain your post.

  • Note information about the violator, if possible.

  • Notify your Supervisor.

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.