WORKPLACE AUDIT / INSPECTION REPORT - Field

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

1. Employee/Personal Protection/Trench Integrity

• 1.1. Are employees protected from loose material which could fall into the trench?

  Yes

  No

  N/A

• 1.2. Are emoployees provided with and are they required to wear proper safety equipment? (29CFR 1926.28(a))

  Yes

  No

  N/A

• 1.3. If a hazardous atmosphere is identified, is ventilation provided or is respiratory protection in use? (29CFR 1926.651(g)(1)(ii))

  Yes

  No

  N/A

• 1.4. Are walkways provided when employees or equipment are required to cross over excavation?

  Yes

  No

  N/A

• 1.5. Are walkways that are six feet or more above lower levels of excavations equipped with gaurdrails?

  Yes

  No

  N/A

• 1.6. Have hazardous objects been removed from the excavation area or blocked securely?

  Yes

  No

  N/A

• 1.7. Is heavy equipment mounted on wooden mats to distribute weight?

  Yes

  No

  N/A

• 1.8. Are damaged materials or equipment removed from service?

  Yes

  No

  N/A

• 1.9. Is excavated material stored at least 2 feet from the edge of the excavation?

  Yes

  No

  N/A

• 1.10. Has the soil type been classified?

  Yes

  No

  N/A

• 1.11. Is the location of the trench marked by banners, barricades, or other signals?

  Yes

  No

  N/A

2. Entrance/Exit Precautions

• 2.1. Is a safe means of egress (stairway, ladder, ramp) provided in a trench four feet or more deep?

  Yes

  No

  N/A

• 2.2. Is a ladder within 25 feet from all employees working in a trench 4 feet or more deep?

  Yes

  No

  N/A

3. Competent Persons

• 3.1. Does a competent person inspect the trench at the beginning of each day and throughout the day as needed?

  Yes

  No

  N/A

• 3.2. Is the trench inspected by a competent person following any amount of rain?

  Yes

  No

  N/A

4. Utility Involvement

• 4.1. Have the utility companies been notified of any excavation work scheduled and asked to establish the location of the underground utilities?

  Yes

  No

  N/A

• 4.2. Has the location of all underground utility lines been identified?

  Yes

  No

  N/A

5. Water Accumulation

• 5.1. Is the trench free of standing water or are adequate precautions in place against the hazards of water accumulation?

  Yes

  No

  N/A

• 5.2. Is the proper water removal equipment operating under guidance of a competent person?

  Yes

  No

  N/A

• 5.3. Are diversion ditches or dikes in place to prevent surface water from entering the trench?

  Yes

  No

  N/A

6. Sloping and Benching

• 6.1. Is the sloping and benching system designed per OSHA requirements?

  Yes

  No

  N/A

• 6.2. Is the aluminum hydraulic shoring system designed per OSHA requirements?

  Yes

  No

  N/A

• 6.3. When a combination of sloping and shielding is used, does the shield extend 18 inches above the bottom slope of the excavation?

  Yes

  No

  N/A

7. Hazardous Atmouspheres

• 7.1. Is the air quality in the trench tested if a hazardous atmosphere is suspected?

  Yes

  No

  N/A

8. Emergency Response/First Aid

• 8.1. Is an emergency response program in place?

  Yes

  No

  N/A

• 8.2. Is emergency rescue equipment readily available, in working order, and attended when in use?

  Yes

  No

  N/A

9. Shoring and Shielding Systems

• 9.1. Are employees protected from cave-ins when entering and exiting a shield?

  Yes

  No

  N/A

• 9.2. Are protective support systems installed in a manner that protects employees?

  Yes

  No

  N/A

• 9.3. Are protective support systems dismantled from the bottom up?

  Yes

  No

  N/A

• 9.4. Is the timber shoring system designed per OSHA requirements?

  Yes

  No

  N/A

• 9.5. Is the excavation back filled as the protective system is dismantled?

  Yes

  No

  N/A

• 9.6. Is the shielding system designed per OSHA requirements?

  Yes

  No

  N/A

• 9.7. Are shield free from damage or defects?

  Yes

  No

  N/A

10. Safety Inspections

• 10.1. HAVE CURRENT MISS UTILITY TICKET AND "STATUS" ON JOB SITE. <br> If no ticket indicate reason. If yes, give ticket number(s).

  Yes

  No

  N/A

• 10.2. Reviewed miss utility ticket with employees and job site for proper marking done.

  Yes

  No

  N/A

• 10.3. Haul roads adequate for conditions.

  Yes

  No

  N/A

• 10.4. Traffic patterns set to eliminate accidents.

  Yes

  No

  N/A

• 10.5. Back up alarms provided and operational?

  Yes

  No

  N/A

• 10.6. Saw man using proper PPE.

  Yes

  No

  N/A

• 10.7. Tree fall area clearly marked and kept clean.

  Yes

  No

  N/A

• 10.8. Mobile equipment cab kept clean and free of loose material.

  Yes

  No

  N/A

• 10.9. Equipment pre-operation inspections done to identify unsafe equipment?

  Yes

  No

  N/A

• 10.10. Unsafe equipment tagged and made inoperable until repairs have been completed?

  Yes

  No

  N/A

• 10.11. Seat belts in use on all mobile equipment, except those without ROPS.

  Yes

  No

  N/A

• 10.12. Tracks/Sprockets cleaned as needed.

  Yes

  No

  N/A

11. Inspections/Slings

• 11.1. Are slings, fastenings and attachments inspected for damage or defects by a competent person each day before use?

  Yes

  No

  N/A

12. Synthetic Web Slings

• 12.1. Are all slings marked or coded to show the rated capacities for each type of hitch and type of synthetic web material?

  Yes

  No

  N/A

13. Portable Metal/Fiberglass Ladders

• 13.1. Are ladders maintained in good usable condition at all times?

  Yes

  No

  N/A

14. Personal Protective Equipment (PPE)

• 14.1. Are all employees required to use personal protective equipment as needed?

  Yes

  No

  N/A

• 14.2. Does it fit properly?

  Yes

  No

  N/A

15. Equipment/Supplies

• 15.1. Do you have first aid kits easily accessible to each work area, with necessary supplies available, periodically inspected and replenished as needed?

  Yes

  No

  N/A

16. Flammable/Combustable containers

• 16.1. Are flammable liquids, such as gasoline, kept in an approved safety can?

  Yes

  No

  N/A

• 16.2. Are flammable liquids kept in approved safety cans labeled?

  Yes

  No

  N/A

Additional Comments

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Subcontractors Onsite? If yes, write Subcontractors Company names.

• Subcontractors Onsite?

  yes

  No

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• On site representative. Mike Offutt

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• Auditor's signature

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