Site Safety Audit Form "*" indicates required fields Step 1 of 4 25% Job #* Date* MM slash DD slash YYYY Site Location* Customer* Auditor Name* Foreman* Project Manager* Reporting Office* DivisionIN CivilsIN FiberIN TowerKY CivilsKY DrillProject Type* Scope of Work* Part 1: Job Site Documentation*Does this section apply? Yes No A. Was the Daily Job Safety analysis form filled out and on site?* Yes No N/A B. Are the applicable safety signs posted?* Yes No N/A C. Is there a competent person on site?* Yes No N/A D. Is someone on site certified in First Aid / CPR / BBP?* Yes No N/A E. Has the emergency data form been filled out and posted?* Yes No N/A F. Is there a documented site-specific direction for emergency rescue on site?* Yes No N/A G. If employees are exposed to a fall, is a documented rescue plan and equipment on site?* Yes No N/A File Drop files here or Select files Accepted file types: jpg, jpeg, gif, png, tif, pdf, Max. file size: 50 MB. Part 2: Job Site Conditions (Include Environmentals)*Does this section apply? Yes No A. Is the work site clean of trash?* Yes No N/A B. Are materials store properly and orderly?* Yes No N/A C. Are measures taken to prevent access by unauthorized personnel to the site?* Yes No N/A D. Are areas barricaded or taped off as required?* Yes No N/A E. Is drinking water available?* Yes No N/A F. Are chemical, flammable and combustible liquids stored properly? (i.e. no plastic gas cans)* Yes No N/A G. Are fire extinguishers of the appropriate size and type available and with current inspection tags* Yes No N/A File Drop files here or Select files Accepted file types: jpg, jpeg, gif, png, tif, pdf, Max. file size: 50 MB. Part 3: PPEDoes this section apply? Yes No A. Are employees wearing hard hats?* Yes No N/A B. Are employees wearing proper work boots?* Yes No N/A C. Are safety goggles being use? (if applicable)* Yes No N/A D. Are employees wearing gloves? (if applicable)* Yes No N/A E. Are employees dressed in appropriate work clothing?* Yes No N/A F. Is hearing protection being used? (if applicable)* Yes No N/A File Drop files here or Select files Max. file size: 50 MB. Part 4: Fall Protection Equipment and Use*Does this section apply? Yes No A. Do employees that are exposed to falls have documented training?* Yes No N/A B. Is fall protection equipment being inspected daily and documented?* Yes No N/A C. Is fall protection equipment in working condition?* Yes No N/A D. If employees are using fall protection, are they attached 100%?* Yes No N/A E. Is the proper equipment on the site to complete the task?* Yes No N/A File Drop files here or Select files Max. file size: 50 MB. Part 5: RF*Does this section apply? Yes No A. Have RF hazards been considered (if applicable)?* Yes No N/A B. Is there a procedure in place to account for RF explosure if there is a possibility of overexposure (if applicable)?* Yes No N/A File Drop files here or Select files Max. file size: 50 MB. Part 6: Electrical (Include Overhead)* Yes No A. Are employees familiar with Lock Out / Tag Out procedures?* Yes No N/A B. Is the tower grounded curing construction? (if applicable)* Yes No N/A C. Is the tower grounded curing construction? (if applicable)* Yes No N/A D. Are electrical panels covered when not being worked on?* Yes No N/A E. Are (GFCI's) in use (if appicable)?* Yes No N/A F. Are extension cords in good condition?* Yes No N/A G. Has the Power Company been notified? (if applicable)* Yes No N/A H. Is GFCI on the generator operational?* Yes No N/A File Drop files here or Select files Max. file size: 50 MB. Part 7: Cranes* Yes No A. Are boom trucks or cranes properly cribbed?* Yes No N/A B. Is annual inspection tag current or inspection report available?* Yes No N/A C. Is crane operator qualified and carrying an operator's certificate* Yes No N/A D. Are load charts posted and readily available to crane operator?* Yes No N/A E. Is headache ball properly marked* Yes No N/A F. Is end connection properly secured?* Yes No N/A G. Are daily inspections being conducted and documented?* Yes No N/A H. Are two-way radios being tested daily, if being used?* Yes No N/A I. Is a hand signal chart posted and visible to all personnel on site?* Yes No N/A J. Has personnel lifting plan been filled out and on site?* Yes No N/A File Drop files here or Select files Max. file size: 50 MB. Part 8: Welding* Yes No A. Is the correct PPE being utilized and in good condition?* Yes No N/A B. Is there proper ventilation or air fflow?* Yes No N/A C. Are Air and Acetylene Tanks properly tied down and secured?* Yes No N/A D. Is there an appointed fire watch present?* Yes No N/A E. Is the welder qualified? (certified through training)* Yes No N/A File Drop files here or Select files Max. file size: 50 MB. Part 9: Hoists, Man Lifts, Scissor Lifts & Bucket Trucks* Yes No A. Are daily inspections being completed with documentation on site?* Yes No N/A B. Is operator qualified? (certified through training or qualified through experience)* Yes No N/A C. Are load charts posted and readily available to hoist operator?* Yes No N/A D. Is there an operator's manual for the unit on site?* Yes No N/A E. Are headache ball markings legible?* Yes No N/A F. Is end connection properly secured?* Yes No N/A G. Are all hoists secured and properly anchored for the load intended?* Yes No N/A H. Are controls clearly identified?* Yes No N/A I. Are controls easily accessible to the operator?* Yes No N/A J. Is the hour meter operational and functioning properly* Yes No N/A K. Are two-way radios being tested daily, if being used?* Yes No N/A L. Are all exposed moving parts properly guarded?* Yes No N/A M. Is a hand signal chart posted and visible to all personnel on site?* Yes No N/A N. Is Fall Protection being utilized and serviceable?* Yes No N/A File Drop files here or Select files Max. file size: 50 MB. Part 10: Personnel Lifting* Yes No A. Is the hoist approved for lifting personnel?* Yes No N/A B. Has a pre-lift meeting been held, documented and made available on site?* Yes No N/A C. In the pre-lift plan, was the trial lift completed and documented?* Yes No N/A D. If a personnel platform is on site, does it have an identification plate with the proper data in place?* Yes No N/A E. If a gin pole is being used, does it have a load chart?* Yes No N/A File Drop files here or Select files Max. file size: 50 MB. Part 11: Catheads* Yes No A. Is cathead mounted properly and securely on sufficient anchorage?* Yes No N/A B. Are operator controls in good working condition? (foot pedal or switch)* Yes No N/A C. Is rope of sufficient size, strength, and type for load being lifted?* Yes No N/A D. Is S.W.L. visible on the cathead?* Yes No N/A E. Is the manufacturer's labeling indicating load rating legible?* Yes No N/A F. Is the capstan head free of grooves?* Yes No N/A G. If the cathead is in use, are appropriate communication devices being used (i.e. two-way radios, hand signals, etc.)?* Yes No N/A File Drop files here or Select files Max. file size: 50 MB. Part 12: Rigging and Blocks* Yes No A. Are proper rigging practices being utilized?* Yes No N/A B. Are the tags on synthetic slings legible?* Yes No N/A C. Are synthetic slings in good condition?* Yes No N/A D. Is rigging equipment being inspected daily and the inspection documented?* Yes No N/A E. Are the safeties on all hooks in good condition?* Yes No N/A G. Are tag lines in working condition?* Yes No N/A FileMax. file size: 50 MB.Part 13: Gin Poles* Yes No A. Is pole rigging in good condition? (if visible)* Yes No N/A B. Does the pole have an identification tag? (if visible)* Yes No N/A C. Is the pole lead chart on site that matches the pole?* Yes No N/A D. Is the pole pre-job inspection form filled out and on site or readily available?* Yes No N/A E. Does the sheave in the Rooster Head match the wire rope? (if visible)* Yes No N/A File Drop files here or Select files Max. file size: 50 MB. Part 14: Trenching and Excavation* Yes No A. Are open holes properly guarded?* Yes No N/A B. If employees are in the trench, is is properly sloped and/or benched?* Yes No N/A C. Is the proper equipment o site to perform the work?* Yes No N/A D. Are trench boxes being used and in good condition?* Yes No N/A E. If employees are in the trench, is there proper entry and egress?* Yes No N/A F. Is there a current utility Locate Ticket or Ticket Number onsite and valid?* Yes No N/A File Drop files here or Select files Max. file size: 50 MB. Part 15: Heavy Equipment* Yes No A. Is back-up alarm working properly?* Yes No N/A B. Is Roll Over Protection installed and in good condition?* Yes No N/A C. Are Hazard Lights working properly?* Yes No N/A D. Are buckets and booms free of cracks and defects?* Yes No N/A E. Are personnel clear of the danger area or working radius?* Yes No N/A F. Are seat belts being utilized while equipment is in operation?* Yes No N/A G. Has the equipment been properly secured for transport?* Yes No N/A H. Has there been a daily inspection on the equipment using the Heavy Equipment Inspection Form?* Yes No N/A File Drop files here or Select files Max. file size: 50 MB. Part 16: Hand/Power Tools* Yes No A. Are electrical tools in good condition?* Yes No N/A B. Are the cords in good condition?* Yes No N/A C. Are they properly grounded or double insulated?* Yes No N/A D. Are proper guards in place?* Yes No N/A E. Are the hand tools free from cracks, damage, and modifications?* Yes No N/A File Drop files here or Select files Max. file size: 50 MB. Part 17: Ladders* Yes No A. Are units well maintained and in good working order?* Yes No N/A B. Are ladders at the proper slogpe? (4:1 ratio)* Yes No N/A C. Does the ladder extend 36 inches past the landing?* Yes No N/A D. Is the ladder stable, on good ground?* Yes No N/A E. Are ladders properly secured? (Tower Access)* Yes No N/A File Drop files here or Select files Max. file size: 50 MB. Part 18: Vehicles* Yes No A. Is the vehicle interior clean?* Yes No N/A B. Is the vehicle exterior clean (if conditions are suitable)?* Yes No N/A C. Does the vehicle have a fire extinguisher with a rating of 2.5 ABC?* Yes No N/A D. Is the fire extinguisher location identified?* Yes No N/A E. Is a well-stocked first-aid kit located in the vehicle?* Yes No N/A F. Is the first aid location marked and identified?* Yes No N/A G. Is safety form S-007 in the glove box in case of an accident?* Yes No N/A H. Has an annual inspection report been completed for the vehicle?* Yes No N/A I. Circle for Safety Completed?* Yes No N/A J. Has the appropriate paperwork been completed?* Yes No N/A File Drop files here or Select files Max. file size: 50 MB. Part 19: D.O.T. Drivers and Vehicles* Yes No A. Is CDL valid for equipment being used?* Yes No N/A B. Do drivers have CDL/DOT Medical card?* Yes No N/A C. Is Drivers Daily Log (Hours of Service) current? (if applicable)* Yes No N/A D. Are Daily Vehicle Inspection Reports (DVIR) current?* Yes No N/A E. Is vehicle properly labeled on each side?* Yes No N/A F. Are emergency reflectors in the vehicle?* Yes No N/A File Drop files here or Select files Max. file size: 50 MB. Overall Impression of Visit* Outstanding (No Deficiencies) Above Average Average Below Average Amount of Time Spent on This Visit*HoursDaysNecessary to Follow up with Written Documentation?* Yes No If any deficiencies, were they corrected immediately?* Yes No N/A Comments:This Report Was Reviewed With* Foreman Crew Crew Members* Add RemoveForeman SignatureForeman Typed Name Date MM slash DD slash YYYY List*Item #Compliance Completed ByDateNoted DeficiencyCourse of Action Add RemoveThe Department Director states compliance of all listed deficiencies by submitting this electronic form to the Safety DirectorManagement CommentsProject Manager SignatureProject Manager Typed Name Date MM slash DD slash YYYY Division Director SignatureDivision Director Typed Name Date MM slash DD slash YYYY Safety DirectorSafety Director Typed Name Date MM slash DD slash YYYY
