VIOX/EFS SAFETY DUE DILIGENCE AUDIT

• Audit Title

• Client / Site

• Copies to:

• Total Campus Square Feet Under Roof

• Conducted on

  Date

• Prepared by

• Location
  Address

• Accompanied By:

• Planned Staffing:

FACILITY AND SCOPE OF WORK AREAS

Roofs

• Sufficient ladder or stairway in place for roof access

  Yes

  No

  N/A

• Sufficient parapet wall 39" - 42"

  Yes

  No

  N/A

• Skylights Present?

  Yes

  No

  N/A

• Sufficiently Guarded/Protected?

  Yes

  No

  N/A

Confined Space

• Confined Spaces present?

  Yes

  No

  N/A

• If yes, are they all identified and labeled?

  Yes

  No

  N/A

• Are they in areas we service, or within our scope of services?

  Yes

  No

  N/A

• Confined Space comments:

HVAC related

• Boilers Present?

  Yes

  No

  N/A

• If yes, do we manage the inspections?

  Yes

  No

  N/A

• If self perform, check if licensed operators (state specific) are required.

• Perform PM/Service of HVAC equipment?

  Yes

  No

  N/A

• Refrigerant Tracking Required?

  Yes

  No

  N/A

HEALTH, WELFARE AND REGULATORY

• Address of Preferred Urgent Care Facility

• First Aid supplies needed

  Yes

  No

  N/A

• Safety Data Sheets and Safe Work Practices accessible?

  Yes

  No

  N/A

• Emergency Preparedness: Evacuation routes posted and plan available for annual review?

  Yes

  No

  N/A

• Safety OSHA and labor law posters posted and accessible for employees?

  Yes

  No

  N/A

HOUSEKEEPING

• At the time of the audit are Site Housekeeping/Controls evident?

  Yes

  No

  N/A

• At the time of the audit is Material Stacked and stable around the facility?

  Yes

  No

  N/A

• At the time of the audit are Flammable - combustibles properly stored/access and access clear

  Yes

  No

  N/A

• At the time of the audit were Passageways/walkways clear and maintained?

  Yes

  No

  N/A

• Other Housekeeping Comments:

PERSONAL PROTECTIVE EQUIPMENT REQUIRED

• PPE Identified:

  Select Hard Hat or Bump Cap for Appropriate Hazards Eye Protection For Appropriate Hazards Foot Protection - Steel or Composite Toe Foot Protection Metatarsal Guards Hearing Protection For Appropriate Hazards Hand Protection Appropriate For Hazards Respiratory Protection Appropriate for the Task or Hazard NFPA Kit with Appropriate Arc Rating Arc Rated Uniforms

  • Hard Hat or Bump Cap for Appropriate Hazards
  • Eye Protection For Appropriate Hazards
  • Foot Protection - Steel or Composite Toe
  • Foot Protection Metatarsal Guards
  • Hearing Protection For Appropriate Hazards
  • Hand Protection Appropriate For Hazards
  • Respiratory Protection Appropriate for the Task or Hazard
  • NFPA Kit with Appropriate Arc Rating
  • Arc Rated Uniforms

SAFETY PROCEDURES

• Pre-Task planning a part of work procedurees as a Mandatory EFS Rule

  Yes

  No

  N/A

• Hazardous Energy Control Program - Lock Out/Tag Out will apply as a Mandatory EFS Rule

  Yes

  No

  N/A

• NFPA 70E Arc Flash Procedures are to be followed per EFS Policy

  Yes

  No

  N/A

• When Applicable EFS Confined Space Entry Procedure and Policy Must be Followed

  Yes

  No

  N/A

• Hazard Communication GHS labeling will apply to all chemicals and containers.

  Yes

  No

  N/A

• Other Safety Procedure Comments:

LADDERS, RAMPS, AND STAIRS

• At the time of the audit are Ladders part of an inspection program?

  Yes

  No

  N/A

• At the time of the audit are the ladders observed maintained and in good condition?

  Yes

  No

  N/A

• Do Side rails extend 3' above top platform?

  Yes

  No

  N/A

• Are Handrails provided as required for steps and ramps with elevation changes above 19"?

  Yes

  No

  N/A

• Other ladder comments:

ENVIRONMENTAL

• EPA Generator status?

  Large quantity generator

  Small quantity generator

• Do we have a role in the management of Hazardous waste?

  Yes

  No

  N/A

• At the time of the audit are Universal wastes labeled, separated and stored properly

  Yes

  No

  N/A

• At the time of the audit are used lamps and ballasts properly managed?

  Yes

  No

  N/A

• At the time of the audit are used batteries properly managed?

  Yes

  No

  N/A

• Are Used refrigerant oils managed?

  Yes

  No

  N/A

• Are Recovered refrigerants managed?

  Yes

  No

  N/A

• Are Used electronic circuit boards managed?

  Yes

  No

  N/A

• Are Used mercury switches managed?

  Yes

  No

  N/A

• Are spent Fluorescent Bulbs managed?

  Yes

  No

  N/A

• Other Universal waste comments:

COMPANY TRUCK/VAN

• Will there be a Company Van/Truck assigned to the site?

  Yes

  No

  N/A

• If moving compressed cylinders, always assure they are secure and have proper storage racks.

• Assure an accident kit is on board.

• Assure a fire extinguisher is aboard.

• Always assure ladders are properly secured to the roof rack. (no bungee cords)

• Always assure good housekeeping is maintained (Good2Go)

• Assure any chemicals are labeled and properly stored.

• Assure the cab is clean and properly maintained at all times..

• Other vehicle related comments:

FIRE PREVENTION/PROTECTION

• Perform Sprinkler and PIV Inspections?

  Yes

  No

  N/A

• Exercise PIV's?

  Yes

  No

  N/A

• Perform monthly Fire Extinguisher Inspections?

  Yes

  No

  N/A

• Other fire system related comments:

SAFETY PERMITS

• Obtained as required per Site/EFS Policy

  Select Hot Work Confined Space Fire Impairment Roof Access Work From Elevations

  • Hot Work
  • Confined Space
  • Fire Impairment
  • Roof Access
  • Work From Elevations

• Smoking control in areas of flammable material

  Yes

  No

  N/A

• Fie extinguishers present as required by permit

  Yes

  No

  N/A

SCAFFOLDING

• Will we be working with/setting up any scaffolds? If Yes:

  Yes

  No

  N/A

• Assure it is Erected/Dismantled, supervised by a competent person

  Yes

  No

  N/A

• Assure all Connections secured

  Yes

  No

  N/A

• Assure Platforms, full width - 2"x10" planks secured

  Yes

  No

  N/A

• Assure Scaffold tied to structure every 20 ft

  Yes

  No

  N/A

• Assure Gaurdrails 42" highly/stable

  Yes

  No

  N/A

• Assure Materials are in good condition

  Yes

  No

  N/A

• Assure Mobile scaffolds are stationary - no ride

  Yes

  No

  N/A

• Assure Safe access/fall protection provided/used

  Yes

  No

  N/A

• Assure they are designed properly for height and weight

  Yes

  No

  N/A

• Assure they are properly inspected

  Yes

  No

  N/A

• Assure they are plumb and braced properly

  Yes

  No

  N/A

ADDITIONAL INFORMATION

• Inspector's Comments: (Document any critical observations, serious safety violations observed, employee(s) counseling required deficeincy training and/or disciplinary actions.

AUDITOR SIGNATURE

• Inspector

  Sign