Welcome

Welcome.

  • Audit Title

  • Document No.

  • Location
  • Conducted on

  • Client / Site

  • Prepared by

  • Personnel

Site Control

Site Control

  • Site Control: Is the site secure from the public?

  • Site Control: Is the site secure from the public?

  • Are fences properly erected and secured? Are dumpsters properly secured?

  • Are fences properly erected and secured? Are dumpsters properly secured?

  • Are gates monitored or kept locked?

  • Are gates monitored or kept locked?

  • Are all tools, equipment, and machinery properly stowed?

  • Are all tools, equipment, and machinery properly stowed?

Documentation

Documentation

  • Documentation: Are IIPP, EHSMS, FHA's, MSDSs, Incident Investigations, and Regulatory Postings available? HazCom Program? Other?

  • Documentation: Are IIPP, EHSMS, JHA's, MSDS, Incident Investigations, and Regulatory Postings available? HazCom Program? Other?

Fall Protection

Fall Protection

  • Fall Protection: Work performed at heights over 6' protected?

  • Fall Protection: Work performed at heights over 6' protected?

  • Has fall protection plan been employed?

  • Has fall protection plan been employed?

  • Are anchorages 5000lbs or greater for each tie off person?

  • Are anchorages 5000lbs or greater for each tie off person?

  • Are Horizontal lifelines used with engineered anchorages?

  • Are Horizontal lifelines used with engineered anchorages?

  • Are scaffolds and ladders properly setup and secured?

  • Are scaffolds and ladders properly setup and secured?

Excavation

Excavation

  • Excavation: Are depths over 5 feet properly benched, sloped, or shored?

  • Excavation: Are depths over 5 feet properly benched, sloped, or shored?

  • Is competent person on-site? Documented soils classifications and methods?

  • Is competent person on-site? Documented soils classifications and methods?

  • Is benching or shoring properly employed, when required?

  • Is benching or shoring properly employed, when required?

  • Access/Egress/Air Monitoring adequate, rescue plan when required?

  • Access/Egress/Air Monitoring adequate, rescue plan when required?

Electrical Safety

Electrical Safety

  • Electrical Safety: Is temporary electrical service with GFCI installed?

  • Electrical Safety: Is temporary electrical service with GFCI installed?

  • Are extension cords, spider boxes, lighting adequate and properly used?

  • Are extension cords, spider boxes, lighting adequate and properly used?

  • Is GFCI employed near wet locations?

  • Is GFCI employed near wet locations?

  • Are power tools grounded or double insulated and used per manufacturer specs?

  • Are power tools grounded or double insulated and used per manufacturer specs?

  • Is LOTO properly employed?

  • Is LOTO properly employed?

Confined Spaces

Confined Spaces.

  • Confined Spaces: Are confined spaces identified and labeled?

  • Confined Spaces: Are confined spaces identified and labeled?

  • Is there a written PRCS program?

  • Is there a written PRCS program?

  • Are documented permits available for review and accurate?

  • Are documented permits available for review and accurate?

  • Is rescue team trained and available for entry?

  • Is rescue team trained and available for entry?

  • Is ventilation properly setup and employed?

  • Is ventilation properly setup and employed?

PPE

PPE

  • PPE: Have hazard assessments been performed and TASK JSA's prepared?

  • PPE: Have hazard assessments been performed and TASK JSA's prepared?

  • Is PPE worn per JSA and IIPP requirements?

  • Is PPE worn per JSA and IIPP requirements?

  • Is a written respiratory protection plan available?

  • Is a written respiratory protection plan available?

General Housekeeping

General Housekeeping

  • General Housekeeping: Is housekeeping adequate?

  • General Housekeeping: Is housekeeping adequate?

  • Are open holes covered?

  • Are open holes covered?

  • Is all rebar protected from personnel impalement or slips, trips, and falls?

  • Is all rebar protected from personnel impalement or slips, trips, and falls?

  • Are all walking surfaces and emergency access and egress ways adequate?

  • Are all walking surfaces and emergency access and egress ways adequate?

  • Is all refuse and construction debris disposed of properly?

  • Is all refuse and construction debris disposed of properly?

Fire Safety

Fire Safety

  • Fire Safety: Are fire extinguishers adequate in number and maintained properly?

  • Fire Safety: Are fire extinguishers adequate in number and maintained properly?

  • Are flammables and combustibles properly stored, dispensed?

  • Are flammables and combustibles properly stored, dispensed?

  • Are fire lanes properly maintained? Smoking prohibited on site?

  • Are fire lanes properly maintained? Smoking prohibited on site?

Hot Work

Hot Work

  • Hot Work: Is a hot work permit program employed?

  • Hot Work: Is a hot work permit program employed?

Heavy Equipment and Machinery

Heavy Equipment and Machinery

  • Heavy Equipment and Machinery: Daily equipment inspections? Are operators qualified?

  • Heavy Equipment and Machinery: Daily equipment inspections? Are operators qualified?

  • Spotters used?

  • Spotters used?

  • Are certified flag personnel used at site controls gates to public roads?

  • Are certified flag personnel used at site controls gates to public roads?

Industrial Hygene

Industrial Hygiene

  • Industrial Hygiene: Are all dusts fumes and mists controlled?

  • Industrial Hygiene: Are all dusts fumes and mists controlled?

  • Are IH sampling documents available for review?

  • Are IH sampling documents available for review?

  • Are welding activities shielded and respirators employed, when required?

  • Are welding activities shielded and respirators employed, when required?

  • Are all spaces adequately ventilated, lighted, and noise controlled?

  • Are all spaces adequately ventilated, lighted, and noise controlled?

  • Is hearing protection used based on noise surveys or manufacturer requirements?

  • Is hearing protection used based on noise surveys or manufacturer requirements?

Cranes, Hoists, and Lifts

Cranes, Hoists, and Lifts

  • Crane, Hoists, and Lifts?

  • Crane, Hoists, and Lifts?

  • Have crane lift plans been prepared and reviewed?

  • Have crane lift plans been prepared and reviewed?

  • Are tag lines employed, where appropriate?

  • Are tag lines employed, where appropriate?

Compressed Gases

Compressed Gases

  • Compressed Gases: Are cylinders properly stored?

  • Compressed Gases: Are cylinders properly stored?

Audit Findings

Audit Findings

  • Safety Assessment Findings

  • Safety Assessment Findings

  • Safety Assessment Findings

  • Safety Assessment Findings

  • Safety Assessment Findings

  • Safety Assessment Findings

  • Safety Assessment Findings

  • Safety Assessment Findings

  • Safety Assessment Findings

  • Safety Assessment Findings

Corrective Action Plan

Corrective Action Plan

  • What is the corrective action(s) planned/ taken? Were employees trained on the action(s) planned/ taken?

  • Projected Date of completion

  • Approving Supervisor's Signature

  • What is the corrective action(s) planned/ taken? Were employees trained on the action(s) planned/ taken?

  • Projected Date of completion

  • Approving Supervisor's Signature

  • What is the corrective action(s) planned/ taken? Were employees trained on the action(s) planned/ taken?

  • Projected Date of completion

  • Approving Supervisor's Signature

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.