Welcome
Welcome.
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Audit Title
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Document No.
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Location
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Conducted on
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Client / Site
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Prepared by
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Personnel
Site Control
Site Control
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Site Control: Is the site secure from the public?
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Site Control: Is the site secure from the public?
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Are fences properly erected and secured? Are dumpsters properly secured?
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Are fences properly erected and secured? Are dumpsters properly secured?
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Are gates monitored or kept locked?
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Are gates monitored or kept locked?
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Are all tools, equipment, and machinery properly stowed?
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Are all tools, equipment, and machinery properly stowed?
Documentation
Documentation
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Documentation: Are IIPP, EHSMS, FHA's, MSDSs, Incident Investigations, and Regulatory Postings available? HazCom Program? Other?
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Documentation: Are IIPP, EHSMS, JHA's, MSDS, Incident Investigations, and Regulatory Postings available? HazCom Program? Other?
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Fall Protection
Fall Protection
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Fall Protection: Work performed at heights over 6' protected?
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Fall Protection: Work performed at heights over 6' protected?
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Has fall protection plan been employed?
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Has fall protection plan been employed?
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Are anchorages 5000lbs or greater for each tie off person?
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Are anchorages 5000lbs or greater for each tie off person?
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Are Horizontal lifelines used with engineered anchorages?
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Are Horizontal lifelines used with engineered anchorages?
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Are scaffolds and ladders properly setup and secured?
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Are scaffolds and ladders properly setup and secured?
Excavation
Excavation
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Excavation: Are depths over 5 feet properly benched, sloped, or shored?
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Excavation: Are depths over 5 feet properly benched, sloped, or shored?
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Is competent person on-site? Documented soils classifications and methods?
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Is competent person on-site? Documented soils classifications and methods?
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Is benching or shoring properly employed, when required?
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Is benching or shoring properly employed, when required?
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Access/Egress/Air Monitoring adequate, rescue plan when required?
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Access/Egress/Air Monitoring adequate, rescue plan when required?
Electrical Safety
Electrical Safety
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Electrical Safety: Is temporary electrical service with GFCI installed?
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Electrical Safety: Is temporary electrical service with GFCI installed?
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Are extension cords, spider boxes, lighting adequate and properly used?
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Are extension cords, spider boxes, lighting adequate and properly used?
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Is GFCI employed near wet locations?
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Is GFCI employed near wet locations?
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Are power tools grounded or double insulated and used per manufacturer specs?
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Are power tools grounded or double insulated and used per manufacturer specs?
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Is LOTO properly employed?
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Is LOTO properly employed?
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Confined Spaces
Confined Spaces.
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Confined Spaces: Are confined spaces identified and labeled?
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Confined Spaces: Are confined spaces identified and labeled?
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Is there a written PRCS program?
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Is there a written PRCS program?
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Are documented permits available for review and accurate?
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Are documented permits available for review and accurate?
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Is rescue team trained and available for entry?
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Is rescue team trained and available for entry?
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Is ventilation properly setup and employed?
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Is ventilation properly setup and employed?
PPE
PPE
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PPE: Have hazard assessments been performed and TASK JSA's prepared?
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PPE: Have hazard assessments been performed and TASK JSA's prepared?
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Is PPE worn per JSA and IIPP requirements?
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Is PPE worn per JSA and IIPP requirements?
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Is a written respiratory protection plan available?
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Is a written respiratory protection plan available?
General Housekeeping
General Housekeeping
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General Housekeeping: Is housekeeping adequate?
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General Housekeeping: Is housekeeping adequate?
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Are open holes covered?
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Are open holes covered?
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Is all rebar protected from personnel impalement or slips, trips, and falls?
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Is all rebar protected from personnel impalement or slips, trips, and falls?
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Are all walking surfaces and emergency access and egress ways adequate?
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Are all walking surfaces and emergency access and egress ways adequate?
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Is all refuse and construction debris disposed of properly?
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Is all refuse and construction debris disposed of properly?
Fire Safety
Fire Safety
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Fire Safety: Are fire extinguishers adequate in number and maintained properly?
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Fire Safety: Are fire extinguishers adequate in number and maintained properly?
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Are flammables and combustibles properly stored, dispensed?
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Are flammables and combustibles properly stored, dispensed?
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Are fire lanes properly maintained? Smoking prohibited on site?
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Are fire lanes properly maintained? Smoking prohibited on site?
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Hot Work
Hot Work
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Hot Work: Is a hot work permit program employed?
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Hot Work: Is a hot work permit program employed?
Heavy Equipment and Machinery
Heavy Equipment and Machinery
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Heavy Equipment and Machinery: Daily equipment inspections? Are operators qualified?
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Heavy Equipment and Machinery: Daily equipment inspections? Are operators qualified?
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Spotters used?
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Spotters used?
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Are certified flag personnel used at site controls gates to public roads?
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Are certified flag personnel used at site controls gates to public roads?
Industrial Hygene
Industrial Hygiene
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Industrial Hygiene: Are all dusts fumes and mists controlled?
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Industrial Hygiene: Are all dusts fumes and mists controlled?
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Are IH sampling documents available for review?
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Are IH sampling documents available for review?
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Are welding activities shielded and respirators employed, when required?
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Are welding activities shielded and respirators employed, when required?
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Are all spaces adequately ventilated, lighted, and noise controlled?
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Are all spaces adequately ventilated, lighted, and noise controlled?
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Is hearing protection used based on noise surveys or manufacturer requirements?
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Is hearing protection used based on noise surveys or manufacturer requirements?
Cranes, Hoists, and Lifts
Cranes, Hoists, and Lifts
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Crane, Hoists, and Lifts?
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Crane, Hoists, and Lifts?
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Have crane lift plans been prepared and reviewed?
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Have crane lift plans been prepared and reviewed?
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Are tag lines employed, where appropriate?
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Are tag lines employed, where appropriate?
Compressed Gases
Compressed Gases
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Compressed Gases: Are cylinders properly stored?
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Compressed Gases: Are cylinders properly stored?
Audit Findings
Audit Findings
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Safety Assessment Findings
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Safety Assessment Findings
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Safety Assessment Findings
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Safety Assessment Findings
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Safety Assessment Findings
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Safety Assessment Findings
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Safety Assessment Findings
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Safety Assessment Findings
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Safety Assessment Findings
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Safety Assessment Findings
Corrective Action Plan
Corrective Action Plan
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What is the corrective action(s) planned/ taken? Were employees trained on the action(s) planned/ taken?
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Projected Date of completion
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Approving Supervisor's Signature
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What is the corrective action(s) planned/ taken? Were employees trained on the action(s) planned/ taken?
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Projected Date of completion
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Approving Supervisor's Signature
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What is the corrective action(s) planned/ taken? Were employees trained on the action(s) planned/ taken?
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Projected Date of completion
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Approving Supervisor's Signature