Title Page
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Audit Title ( Val's Job #)
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City
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Conducted on
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Prepared by
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Site conditions (weather/environmental)
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FPI Level
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PAL Level
- A
- B
- C
- D
- E
- Ev
- RFW
Site Safety Assurance Visit
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Foreman name
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Crew member names
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Fire watch name
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JSA in place, reviewed and signed?
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Other site documentation
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Equipment has been Inspected?
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Equipment has been properly greased?
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Are fire tools in place?
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Are the fire tools serviceable
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Ice chest and water
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Are illness prevention protocols being complied with?
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First Aid Kit Serviceable?
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Is ALL mandatory PPE being worn?
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If needed, is additional required PPE in use?
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What PPE is required to meet the standard?
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If needed, are silica mitigation procedures being implemented?
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Employees are performing their work in a safe manner
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Walking surfaces are even and uncluttered
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Jobsite is orderly , with rubbish and waste disposed of correctly
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Have mark-outs been performed?
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Is template in use?
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Why is it not able to be used?
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Pins and whip checks are in place on compressor hoses
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Precautions taken for working on a slope or grade
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If needed is fall protection in place
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Condition of equipment
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Is work area protected?
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Is the public protected or shielded from hazards?
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If in close proximity to road, is signage in place?
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Is traffic control set up properly?
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Site notes or comments
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Sign off
