Work Zone Safety

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Photo of work area

  Media

General Safety

• Was a job briefing conducted before work commenced?

  Yes

  No

  N/A

• Is a two-way radio or cell phone available in case of emergency?

  Yes

  No

  N/A

Work Zone Protection

• Diagram

  Drawing

• Are advanced warning signs in place?

  Yes

  No

  N/A

• Are changes in the traffic pattern clearly marked and communicated with signage?

  Yes

  No

  N/A

• Is the work zone clearly marked with the appropriate size and number of traffic cones?

  Yes

  No

  N/A

• If traffic conditions or location warrant, is a Flagger present?

  Yes

  No

  N/A

Personal Protective Equipment

• Are all employees wearing the appropriate ANSI Class 2 traffic safety vest at a minimum?

  Yes

  No

  N/A

• Are all employees wearing the appropriate PPE for the hazards present at this job site? (ex. Safety toe boots, long pants, knee pads, gloves, respirator, face shield, protective eyewear, head protection, hearing protection, etc)

  Yes

  No

  N/A

Utility Safety

• If digging, trenching, auguring, etc; was a utility locate ticket obtained and the work site clearly marked as to the location of underground utilities or flagged affirmatively indicating a lack of utilities (Red=Electric, Yellow=Gas, Orange=Communications, Blue=Water, Green=Sewer)

  Yes

  No

  N/A

• Are all excavators, elevated dump truck bodies and other mobile equipment maintaining a minimum of 10' clearance from any overhead electrical or communication lines?

  Yes

  No

  N/A

• Are all cranes, derricks (not operated by the electric utility), and hoists in use maintaining a minimum of a 20' clearance from all overhead electrical and communication wires?

  Yes

  No

  N/A

• Electric Dept: are bucket trucks properly barricaded and marked while working energized lines?

  Yes

  No

  N/A

• Electric Dept: If bucket trucks are working energized lines, are ground crews remaining clear of vehicle?

  Yes

  No

  N/A

• Electric Dept: Rubber gloves and/or sleeves used when required?

  Yes

  No

  N/A

• Electric Dept: adequate rubber cover-up used?

  Yes

  No

  N/A

• Electric Dept: Insulated tools used correctly when required?

  Yes

  No

  N/A

• Electric Dept: Hold cards used when required?

  Yes

  No

  N/A

Excavation

• Excavation properly barricaded?

  Yes

  No

  N/A

• Protective systems properly used? (shoring, shielding, sloping, etc)

  Yes

  No

  N/A

• Are sump pumps being used to manage water effectively?

  Yes

  No

  N/A

• Is the spoil pile at least 2' from the edge of the excavation?

  Yes

  No

  N/A

• Is adequate egress provided for all employees working in the excavation?

  Yes

  No

  N/A

Vehicles

• Are appropriate warning lights on vehicles working and in use?

  Yes

  No

  N/A

• Are all vehicles parked safely (Not creating blind spots for traffic, properly marked with cones if in traffic lane, properly positioned as a barrier vehicle, etc.)

  Yes

  No

  N/A

• Are vehicles near confined space egress points and excavations shut off unless absolutely necessary for task?

  Yes

  No

  N/A

• Are all vehicles onsite equipped with a (properly stocked) First Aid kit?

  Yes

  No

  N/A

• If equipped with an AED; is it properly stocked, pads and batteries are not expired?

  Yes

  No

  N/A

• Is a blood bourne pathogen kit in each vehicle?

  Yes

  No

  N/A

• Does the vehicle appear to be free from defects and operating normally?

  Yes

  No

  N/A

• Are wheel chocks being used on all bucket trucks, digger/derricks, and/or cranes while in use or otherwise according to employer policy?

  Yes

  No

  N/A

Additional Comments

• Additional comments: