Weekly Jobsite Safety Survey

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

1. Fall Protection

• 1.1. Fall risks of 6' or more? (including voids, pits, and trenches)<br>

  Safe

  At Risk

  N/A

• 1.2. Roof/Floor/Wall Opening Protected?

  Safe

  At Risk

  N/A

• 1.3. Unsafe or incomplete edge protection?

  Safe

  At Risk

  N/A

• 1.4 Competent Person Designated?

  Yes

  No

  N/A

• 1.5 Harnesses/Lanyards?

  Yes

  No

  N/A

2. Excavation Safety

• 2.1 Competent Person?

  Yes

  No

  N/A

• 2.2 Trench Protection?

  Safe

  At Risk

  N/A

• 2.3 Spoil/Equipment Distance

  Safe

  At Risk

  N/A

• 2.4 Ladder/Access

  Safe

  At Risk

  N/A

• 2.5. Unlicensed operators?

  Safe

  At Risk

  N/A

3.Ladders

• 3.2. Unsafe or damaged ladders?

  Safe

  At Risk

  N/A

• 3.2. Unsafe positioning of ladders?

  Safe

  At Risk

  N/A

• 3.3. Ladder not properly secured?

  Safe

  At Risk

  N/A

• 3.4.Ladder unsuitable for job? (e.g. metal ladder used for electrical work)

  Safe

  At Risk

  N/A

4. Hand/Power Tool Safety

• 4.1. Maintenance /Storage

  Safe

  At Risk

  N/A

• 4.2. Proper Use/Condition

  Yes

  No

  N/A

• 4.3. Mechanical Gaurding

  Yes

  No

  N/A

5. Electrical Hazards

• 5.1. Unsafe electrical leads? (damaged, out of test date or untested)

  Safe

  At Risk

  N/A

• 5.2. Contact with overhead electrical lines?

  Safe

  At Risk

  N/A

• 5.3.Overloading outlets?

  Safe

  At Risk

  N/A

• 5.4. Electrical equipment near water?

  Yes

  No

  N/A

• 5.5. Electrical equipment near flammables?

  Yes

  No

  N/A

• 5.6. Electrical leads that may be damaged from contact with moving machinery parts?

  Yes

  No

  N/A

• 5.7. Lack of Lock-out/tag-out (LOTO) procedures for electrical equipment?

  Safe

  At Risk

  N/A

6. General Safety

• 6.1 Site Safety Plan/ Emergency Procedures

  Safe

  At Risk

  N/A

• 6.2 Housekeeping

  Safe

  At Risk

  N/A

• 6.3 Chemical Exposures

  Safe

  At Risk

  N/A

• 6.4. Lack of/or inadequate training, licenses, skills, experience?

  Safe

  At Risk

  N/A

• 6.5. Lack of/or inadequate incident notification procedures?

  Safe

  At Risk

  N/A

7. Personal Protective Equipment

• 7.1. Hard Hats

  Yes

  No

  N/A

• 7.2. Eye/Face/Hearing

  Yes

  No

  N/A

• 7.3. Safety Shoes/ Gloves

  Yes

  No

  N/A

• 7.4. Proper Clothing

  Yes

  No

  N/A

8. Crane & Rigging

• 8.1Daily Inspections Preformed?

  Yes

  No

  N/A

• 8.2. Hoist/Sling Use/Condition

  Safe

  At Risk

  N/A

• 8.3. Qualified Operators

  Yes

  No

  N/A

Corrective Actions

• Enter any corrective actions that will be undertaken

Sign Off

• On site representative

  Sign

• Auditor's signature

  Sign