safetyaudittestform – Integrity Safety

Safety Audit Form

Date

Job Name

Superintendent/Foreman

Project Manager

Inspected By

Unchecked boxes=Not applicable

GENERAL ADMINISTRATIVE

Written Safety and Hazard Communication programs (APP and SDS binders)

Required postings OSHA L & I, Emergency Numbers, Worker’s Comp, Code of Safe Practices, COVID 19, ETC.

Adequate toilets/ washing facilities

Record of Safety Meetings and Safety Inspections

Hot/Cold stress to workers with proper access to water (H2O)

Adequate lighting in work and walkways

Written Safety and Hazard Communication programs (APP and SDS binders)(Required)

Violation

Violation/Fixed

Photo

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Comments/Action Required

Comments/Action required notes for Written Safety and Hazard Communication programs (APP and SDS binders)

Required postings OSHA L & I, Emergency Numbers, Worker’s Comp, Code of Safe Practices, COVID 19, ETC.(Required)

Violation

Violation/Fixed

Photo

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Comments/Action Required

Comments/Action required notes for Required postings OSHA L & I, Emergency Numbers, Worker’s Comp, Code of Safe Practices, COVID 19, ETC.

Adequate toilets/ washing facilities(Required)

Violation

Violation/Fixed

Photo

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Comments/Action Required

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Record of Safety Meetings and Safety Inspections(Required)

Violation

Violation/Fixed

Photo

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Hot/Cold stress to workers with proper access to water (H2O)(Required)

Violation

Violation/Fixed

Photo

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Comments/Action Required

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Adequate lighting in work and walkways(Required)

Violation

Violation/Fixed

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PERSONAL PROTECTIVE EQUIP / EMERGENCY

Hard hats, vest, and safety glasses being used as needed or 100% of the time

Hearing, face protection, along with respirators, being used when needed and workers medically cleared

Employees aware of emergency procedures

First Aid kit on site- stocked and accessible

First aid personnel on site and identified

Proper work shoes being worn

Hard hats, vest, and safety glasses being used as needed or 100% of the time(Required)

Violation

Violation/Fixed

Photo

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Comments/Action Required

Comments/Action required notes for Hard hats, vest, and safety glasses being used as needed or 100% of the time

Hearing, face protection, along with respirators, being used when needed and workers medically cleared(Required)

Violation

Violation/Fixed

Photo

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Comments/Action Required

Comments/Action required notes for Hearing, face protection, along with respirators, being used when needed and workers medically cleared

Employees aware of emergency procedures(Required)

Violation

Violation/Fixed

Photo

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Comments/Action Required

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First Aid kit on site- stocked and accessible(Required)

Violation

Violation/Fixed

Photo

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First aid personnel on site and identified(Required)

Violation

Violation/Fixed

Photo

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Proper work shoes being worn(Required)

Violation

Violation/Fixed

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EXCAVATIONS

Competent person on site

Collapse protection for all employees in excavation over 4ft. deep WA /5 ft. Fed

No confined space issues with atmosphere

Underground utilities located and lines maintained

Spoils and surcharges at least 2 feet from edge

Seatbelts being worn while in equipment

Proper walkway over trench (18 inches wide)

Competent person on site(Required)

Violation

Violation/Fixed

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Collapse protection for all employees in excavation over 4ft. deep WA /5 ft. Fed(Required)

Violation

Violation/Fixed

Photo

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Comments/Action required notes for Collapse protection for all employees in excavation over 4ft. deep WA /5 ft. Fed

No confined space issues with atmosphere(Required)

Violation

Violation/Fixed

Photo

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Comments/Action Required

Comments/Action required notes for No confined space issues with atmosphere

Underground utilities located and lines maintained(Required)

Violation

Violation/Fixed

Photo

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Comments/Action Required

Comments/Action required notes for Underground utilities located and lines maintained

Spoils and surcharges at least 2 feet from edge(Required)

Violation

Violation/Fixed

Photo

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Comments/Action Required

Comments/Action required notes for Spoils and surcharges at least 2 feet from edge

Seatbelts being worn while in equipment(Required)

Violation

Violation/Fixed

Photo

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Comments/Action Required

Comments/Action required notes for Seatbelts being worn while in equipment

Proper walkway over trench (18 inches wide)(Required)

Violation

Violation/Fixed

Photo

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Comments/Action Required

Comments/Action required notes for Proper walkway over trench (18 inches wide)

SCAFFOLDING

Competent person on site and scaffold signed off each day of use(Required)

Violation

Violation/Fixed

Photo

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Plumb and level and fully braced(Required)

Violation

Violation/Fixed

Photo

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Scaffold grade planking and fully planked(Required)

Violation

Violation/Fixed

Photo

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Comments/Action required notes for Scaffold grade planking and fully planked

Fall protection above 7.5 CA feet (10 WA&OR)(Required)

Violation

Violation/Fixed

Photo

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Comments/Action required notes for Fall protection above 7.5 CA feet (10 WA&OR)

Proper access(Required)

Violation

Violation/Fixed

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Falling object protection(Required)

Violation

Violation/Fixed

Photo

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Comments/Action required notes for Falling object protection

Tipping restraint at 4:1 ratio (i.e. attached to structure)(Required)

Violation

Violation/Fixed

Photo

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Comments/Action required notes for Tipping restraint at 4:1 ratio (i.e. attached to structure)

14 inches or closer to structure (18 or closer for plastering)(Required)

Violation

Violation/Fixed

Photo

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Comments/Action required notes for 14 inches or closer to structure (18 or closer for plastering)

No employees propelling themselves on top of rolling scaffold(Required)

Violation

Violation/Fixed

Photo

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Proper distance from electrical lines (3 feet for v less than 300)(Required)

Violation

Violation/Fixed

Photo

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Comments/Action required notes for Proper distance from electrical lines (3 feet for v less than 300)

CRANES

Annual and daily inspection log up to date

Outriggers properly positioned and supported

Powerline rules followed

Pinch points from counterweight guarded

Slings and rigging inspected daily and tagged

Operator/ Rigger/ Signal person certification

Annual and daily inspection log up to date(Required)

Violation

Violation/Fixed

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Outriggers properly positioned and supported(Required)

Violation

Violation/Fixed

Photo

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Powerline rules followed(Required)

Violation

Violation/Fixed

Photo

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Comments/Action required notes for Powerline rules followed

Pinch points from counterweight guarded(Required)

Violation

Violation/Fixed

Photo

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Comments/Action required notes for Pinch points from counterweight guarded

Slings and rigging inspected daily and tagged(Required)

Violation

Violation/Fixed

Photo

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Comments/Action required notes for Slings and rigging inspected daily and tagged

Operator/ Rigger/ Signal person certification(Required)

Violation

Violation/Fixed

Photo

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Comments/Action required notes for Operator/ Rigger/ Signal person certification

AERIAL LIFTS

Inspect for damage and service prior to work shift

Excessive weight

All top and mid rails in place

Fall protection used for articulating and reach platforms

Climbing on mid or top rail

Inspect for damage and service prior to work shift(Required)

Violation

Violation/Fixed

Photo

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Excessive weight(Required)

Violation

Violation/Fixed

Photo

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Comments/Action Required

Comments/Action required notes for Excessive weight

All top and mid rails in place(Required)

Violation

Violation/Fixed

Photo

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Comments/Action required notes for All top and mid rails in place

Fall protection used for articulating and reach platforms(Required)

Violation

Violation/Fixed

Photo

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Comments/Action required notes for Fall protection used for articulating and reach platforms

Climbing on mid or top rail(Required)

Violation

Violation/Fixed

Photo

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Comments/Action required notes for Climbing on mid or top rail

HOUSEKEEPING

Work area, passageways, and stairs clear of scrap and debris. Removed regularly.

Site clean with proper trash receptacles

Material storage areas kept orderly and free of debris

Protruding nails in lumber kept cleared from work areas, passageways, and stairs, in and around buildings

Work area, passageways, and stairs clear of scrap and debris. Removed regularly.(Required)

Violation

Violation/Fixed

Photo

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Comments/Action required notes for Work area, passageways, and stairs clear of scrap and debris. Removed regularly.

Site clean with proper trash receptacles(Required)

Violation

Violation/Fixed

Photo

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Comments/Action Required

Comments/Action required notes for Site clean with proper trash receptacles

Material storage areas kept orderly and free of debris(Required)

Violation

Violation/Fixed

Photo

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Comments/Action required notes for Material storage areas kept orderly and free of debris

Protruding nails in lumber kept cleared from work areas, passageways, and stairs, in and around buildings(Required)

Violation

Violation/Fixed

Photo

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Comments/Action required notes for Protruding nails in lumber kept cleared from work areas, passageways, and stairs, in and around buildings

TOOLS, HAND AND POWER

Tool and Cord in good condition

Guards in place

Proper extension cord for tool

Air lines good condition

Powder actuated tools - Proper cartridge storage/disposal and operator license

Tool and Cord in good condition(Required)

Violation

Violation/Fixed

Photo

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Guards in place(Required)

Violation

Violation/Fixed

Photo

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Comments/Action required notes for Guards in place

Proper extension cord for tool(Required)

Violation

Violation/Fixed

Photo

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Comments/Action required notes for Proper extension cord for tool

Air lines good condition(Required)

Violation

Violation/Fixed

Photo

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Comments/Action required notes for Air lines good condition

Powder actuated tools - Proper cartridge storage/disposal and operator license(Required)

Violation

Violation/Fixed

Photo

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Untitled

FALL PROTECTION

Covers over holes and marked “hole” or “cover”

Guardrails 42+ 3 inches midrail and toe boards Deflection less than 3 in. and cable flagged every 6 ft.

Proper use of harness, lanyard and anchor

Proper leading edge SRL

Cover support 200# <12 in. 4x intended load > 12 in.

PFA systems adjusted to keep fall less than 6 feet before arrest begins

Wall openings guarded

Covers over holes and marked “hole” or “cover”(Required)

Violation

Violation/Fixed

Photo

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Comments/Action Required

Comments/Action required notes for Covers over holes and marked “hole” or “cover”

Guardrails 42+ 3 inches midrail and toe boards Deflection less than 3 in. and cable flagged every 6 ft.(Required)

Violation

Violation/Fixed

Photo

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Comments/Action required notes for Guardrails 42+ 3 inches midrail and toe boards Deflection less than 3 in. and cable flagged every 6 ft.

Proper use of harness, lanyard and anchor(Required)

Violation

Violation/Fixed

Photo

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Proper leading edge SRL(Required)

Violation

Violation/Fixed

Photo

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Comments/Action required notes for Proper leading edge SRL

Cover support 200# <12 in. 4x intended load > 12 in.(Required)

Violation

Violation/Fixed

Photo

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Comments/Action required notes for Cover support 200# <12 in. 4x intended load > 12 in.

PFA systems adjusted to keep fall less than 6 feet before arrest begins(Required)

Violation

Violation/Fixed

Photo

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Wall openings guarded(Required)

Violation

Violation/Fixed

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FIRE PROTECTION/PREVENTION

Fire extinguishers provided at least every 3000 sq. feet of combustibles

Monthly inspection completed

No more than 50 feet from flammable liquid storage

Fire extinguisher no more than 75 feet from ordinary combustibles

No more than 50 feet from hot work

Approved Safety cans in use

Fire extinguishers provided at least every 3000 sq. feet of combustibles(Required)

Violation

Violation/Fixed

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Monthly inspection completed(Required)

Violation

Violation/Fixed

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No more than 50 feet from flammable liquid storage(Required)

Violation

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Fire extinguisher no more than 75 feet from ordinary combustibles(Required)

Violation

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No more than 50 feet from hot work(Required)

Violation

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Approved Safety cans in use(Required)

Violation

Violation/Fixed

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Comments/Action required notes for Approved Safety cans in use

ELECTRICAL

All temporary electrical cords are protected by GFCI or assured grounding program

Cords are properly rated for construction use and protected

Cords are free from damage, have strain relief, and all prongs intact

Panels are dead faced and contain all blanks where needed

String lights are in good condition and hung properly

All temporary electrical cords are protected by GFCI or assured grounding program(Required)

Violation

Violation/Fixed

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Cords are properly rated for construction use and protected(Required)

Violation

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Cords are free from damage, have strain relief, and all prongs intact(Required)

Violation

Violation/Fixed

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Panels are dead faced and contain all blanks where needed(Required)

Violation

Violation/Fixed

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String lights are in good condition and hung properly(Required)

Violation

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MATERIAL HANDLING

Forklift Operators are trained & certified

Equipment is being operated w/proper clearances from workers & other equipment

Seat belt worn

Load properly secured on forks

Forklift attended (operator within 25' and can see lift)

Flammable Materials properly stored/labeled

Proper lifting techniques used

Forklift Operators are trained & certified(Required)

Violation

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Equipment is being operated w/proper clearances from workers & other equipment(Required)

Violation

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Seat belt worn(Required)

Violation

Violation/Fixed

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Load properly secured on forks(Required)

Violation

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Forklift attended (operator within 25' and can see lift)(Required)

Violation

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Flammable Materials properly stored/labeled(Required)

Violation

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Proper lifting techniques used(Required)

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HIGHWAY/WORK ZONES

Flagger properly placed on shoulder of road or in closed lane

Warning signs properly spaced

Channelization devices properly used and spaced

Vehicle and pedestrian traffic properly controlled

Proper PPE for flagging worn

Flagger properly placed on shoulder of road or in closed lane(Required)

Violation

Violation/Fixed

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Warning signs properly spaced(Required)

Violation

Violation/Fixed

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Channelization devices properly used and spaced(Required)

Violation

Violation/Fixed

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Vehicle and pedestrian traffic properly controlled(Required)

Violation

Violation/Fixed

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Proper PPE for flagging worn(Required)

Violation

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WELDING AND CUTTING

Proper PPE and shields used

Backflow valves on gas lines

Separated by 20 feet or ½ hour firewall when stored

Proper handling/labeling and storage of cylinders

Fire extinguisher on site and in proper location

Fire watch in place 30 minutes after last hot work

Other workers protected/warned from falling slag

Valve protection caps in place when not in use

Proper PPE and shields used(Required)

Violation

Violation/Fixed

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Backflow valves on gas lines(Required)

Violation

Violation/Fixed

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Separated by 20 feet or ½ hour firewall when stored(Required)

Violation

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Proper handling/labeling and storage of cylinders(Required)

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Fire extinguisher on site and in proper location(Required)

Violation

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Fire watch in place 30 minutes after last hot work(Required)

Violation

Violation/Fixed

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Other workers protected/warned from falling slag(Required)

Violation

Violation/Fixed

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Valve protection caps in place when not in use(Required)

Violation

Violation/Fixed

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LADDERS

No workers standing on top 2 steps of ladder

Folding step ladders must be open & locked when in use

Ladders are set up on appropriate surface

Straight ladders set up at correct pitch and secured

Extend at least 3 ft. above any upper landing level & secured

Free from damage. Broken ladders are tagged out.

Non Conductive ladders near electrical hazards

Proper protection when using ladders around wall openings

No workers standing on top 2 steps of ladder(Required)

Violation

Violation/Fixed

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Folding step ladders must be open & locked when in use(Required)

Violation

Violation/Fixed

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Ladders are set up on appropriate surface(Required)

Violation

Violation/Fixed

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Straight ladders set up at correct pitch and secured(Required)

Violation

Violation/Fixed

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Extend at least 3 ft. above any upper landing level & secured(Required)

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Free from damage. Broken ladders are tagged out.(Required)

Violation

Violation/Fixed

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Non Conductive ladders near electrical hazards(Required)

Violation

Violation/Fixed

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Proper protection when using ladders around wall openings(Required)

Violation

Violation/Fixed

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CONCRETE

Rebar Capping

Proper PPP during pour (rubber boots, long sleeves, gloves, eye protection

Controlled access zone

Proper hoisting/staging area protection- fall

Silica Dust Controls in place see Table 1

Rebar Capping(Required)

Violation

Violation/Fixed

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Proper PPP during pour (rubber boots, long sleeves, gloves, eye protection)(Required)

Violation

Violation/Fixed

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Controlled access zone(Required)

Violation

Violation/Fixed

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Proper hoisting/staging area protection (fall/overhead hazards)(Required)

Violation

Violation/Fixed

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Silica Dust Controls in place see Table 1(Required)

Violation

Violation/Fixed

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HEALTH

Lead or Asbestos controls in place with proper signage

Powder actuated tool warning signs in place

Covid-19 rules followed

Lead or Asbestos controls in place with proper signage(Required)

Violation

Violation/Fixed

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Powder actuated tool warning signs in place(Required)

Violation

Violation/Fixed

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Covid-19 rules followed(Required)

Violation

Violation/Fixed

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CONFINED SPACE

Permit posted at space and properly filled out

Proper fall protection for hazard

Gas detector calibrated, bump tested and active in space

Confined space procedures followed

Permit posted at space and properly filled out(Required)

Violation

Violation/Fixed

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Proper fall protection for hazard(Required)

Violation

Violation/Fixed

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Gas detector calibrated, bump tested and active in space(Required)

Violation

Violation/Fixed

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Confined space procedures followed(Required)

Violation

Violation/Fixed

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General Comments

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Thank you for the opportunity to provide this audit report. If you have any questions, please contact me at the number or email below.

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