Site Safety Audit JDH Site Safety Audit "*" indicates required fields Date* MM slash DD slash YYYY Division*IN CivilsIN FiberIN TowerKY CivilsKY DrillJob #* Project Name/Number* Site Location* Customer* Auditor Name* Foreman* Project Manager* Type of Structure*MonopoleSSTGuyedRooftopWater TankUtility PoleSmall CellOtherScope of Work*AuditPart 1: Job Site Documentation*Does this section apply? Yes No A. Was the JHA conducted and available 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 more than one person on site certified in First Aid / CPR / BBP/AED?* 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. Are SDS's available for the material being used on the jobsite? (Available via digital means and methods acceptable)* Yes No N/A H. If a rigging plan is required, does the approved rigging plan correspond with the on-site conditions?* Yes No N/A I. Is the proper equipment to complete the task on the jobsite?* Yes No N/A J. Are daily tailgate meetings held to review the scope of work?* Yes No N/A K. Before climbing or rigging operations, has the structure owner or NATE guidelines for dig-to-block been evaluated by the competent person?* Yes No N/A L. Is there a stop work authority procedure in place for personnel to report and correct identified hazards without fear of repercussions?* 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. Are the housekeeping responsibilities met and maintained?* Yes No N/A B. Are materials stored 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 H. Are plant and animal hazards addressed and documented?* 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. Is approved eye protection being used?* 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 G. Are employees wearing appropriate high-visibility clothing? (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 the proper equipment on the site to complete the task and in working condition?* Yes No N/A D. Is a documented fall protection plan readily available on the jobsite?* Yes No N/A E. Is a documented fall protection plan readily available on the jobsite?* Yes No N/A F. If employees are using fall protection, are they attached 100%?* Yes No N/A File Drop files here or Select files Max. file size: 50 MB. Part 5: Hot Work/Welding*Does this section apply? Yes No A. Has a Hot Work Permit been completed, if required?* Yes No N/A B. Is the correct PPE being utilized and in good condition?** Yes No N/A C. Is there proper ventilation or air flow?* Yes No N/A D. Is there an appointed fire watch and fire extinguisher 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 6: RF*Does this section apply? Yes No A. Do personnel exposed to RF have documented training?* Yes No N/A B. Have RF hazards been documented (if applicable)?* Yes No N/A C. Is a documented RF plan readily available on the jobsite?* Yes No N/A D. Are personal RF monitors being worn?* Yes No N/A E. Are RF monitors calibrated and charged?* Yes No N/A File Drop files here or Select files Max. file size: 50 MB. Part 7: Electrical (Include Overhead)* Yes No A. Do personnel exposed to electrical hazards have documented training?* Yes No N/A B. Based on the scope of work, are the personnel trained on the Lockout/Tagout procedures?* Yes No N/A C. Are electrical panels covered when not being worked on?* Yes No N/A D. Are Ground Fault Circuit Interrupters (GFCI) being used if permanent wiring is not available?* Yes No N/A E. Are extension cords in good condition?* Yes No N/A F. Are the correct length and gauge of extension cords being utilized?* Yes No N/A G. If necessary, has the power company been notified?* Yes No N/A H. Is there a documented procedure for site-specific electrical hazards that relates to the scope of work?* Yes No N/A File Drop files here or Select files Max. file size: 50 MB. Part 8: Cranes & Boom Trucks* Yes No A. Has the lift plan been completed as per OSHA 1926.1400 subpart CC and reviewed with all personnel on site?* Yes No N/A B. Is there a documented procedure for site-specific electrical hazards that relates to the lift plan?* Yes No N/A C. Is crane operator certified?* Yes No N/A D. Does the signal person have documented training?* Yes No N/A E. Have the operator and signal person established a communication method (two-way radios, signals)?* Yes No N/A F. Is the annual inspection tag or inspection report current, and readily available?* Yes No N/A G. Are load charts readily available?* Yes No N/A H. Are cranes cribbed and level?* Yes No N/A I. Is the block or overhaul (headache) ball properly marked?* Yes No N/A J. Is end termination properly secured?* Yes No N/A K. Have the daily crane and rigging inspections been conducted and documented?* Yes No N/A L. Is a hand signal chart readily available on the jobsite?* Yes No N/A M. Have any known underground conditions been verified?* Yes No N/A File Drop files here or Select files Max. file size: 50 MB. Part 9: Hoists, Bucket Truck* Yes No A. Are daily inspections being completed with documentation on site?* Yes No N/A B. Is the hoist operator qualified per ANSI/ASSP A10.48?* 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 overhaul ball markings legible?* Yes No N/A F. Is end termination properly secured?* Yes No N/A G. Are all hoists secured and properly anchored for the load intended?* Yes No N/A H. Has hoist load test(s) been performed per scope of work?* Yes No N/A I. Are controls clearly identified?* Yes No N/A J. Are controls easily accessible to the operator?* Yes No N/A K. Is the hour meter operational and functioning properly* Yes No N/A L. Are non-trunked, dedicated frequency two-way radios being tested daily, if being used?* Yes No N/A M. Are all exposed moving parts properly guarded?* Yes No N/A N. Is a hand signal chart posted and visible to all personnel on site?* 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 (weight of plaftorm, maximum intended load, employee capacity)?* Yes No N/A E. If a gin pole is being used, does it have a load chart for personnel lifting?* Yes No N/A File Drop files here or Select files Max. file size: 50 MB. Part 11: Capstan Hoists (Catheads)* Yes No A. Does the operator have documented training?* Yes No N/A B. Is there a documented procedure for site-specific electrical hazards that relates to the construction plan?* Yes No N/A C. Has the capstan hoist and mounting system been inspected and documented?* Yes No N/A D. Are operator controls in good working condition? (Foot Pedal or Switch)* Yes No N/A E. Is rope of sufficient size, strength and type for load being lifted?* Yes No N/A F. Is the manufacturer's labeling indicating load rating legible?* Yes No N/A G. Is the capstan drum free of corrosion and grooves?* Yes No N/A H. Have the vehicle wheels been chocked?* Yes No N/A I. Has a communication method been established between the capstan operator and climber?* Yes No N/A File Drop files here or Select files Max. file size: 50 MB. Part 12: Rigging/Material Lifting Components* Yes No A. Are all tags on rigging equipment legible?* Yes No N/A B. Has rigging equipment been inspected per ANSI/ASSP A10.48?* Yes No N/A C. Have all load lines been inspected and in good condition?* Yes No N/A D. Have all tag lines been inspected and in good condition?* Yes No N/A E. Have all blocks been inspected and in good condition?* Yes No N/A F. Have all shackles, hooks, and hardware been inspected and in good condition?* Yes No N/A G. Have all slings been inspected and in good condition?* Yes No N/A FileMax. file size: 50 MB.Part 13: Gin Poles* Yes No A. Has the gin pole been inspected per ANSI/ASSP A10.48?* Yes No N/A B. Have the rigging components and accessories used with the gin pole been inspected and in good condition?* Yes No N/A C. Does the gin pole have identification markings?* Yes No N/A D. Has the gin pole been assembled per the load chart?* Yes No N/A E. Does the sheave in the rooster head / block, match the wire rope size?* Yes No N/A F. Has a trial lift been preformed and documented?* Yes No N/A Has an approved Class 4 rigging plan been established on the jobsite?* Yes No N/A File Drop files here or Select files Max. file size: 50 MB. Part 14: Trenching and Excavation* Yes No A. Has a competent person been identified?* Yes No N/A B. Has both private and public 811 (utility avoidance) been contacted prior to construction?* Yes No N/A C. Have utilities (public and private) been marked?* Yes No N/A D. During drilled shaft operations are fall protection systems in place?* Yes No N/A E. Are systems in place to prevent fall hazards during operations?* Yes No N/A F. Are all open excavations properly barricaded overnight?* Yes No N/A G. Have personnel in the trench been properly protected from cave-in?* Yes No N/A H. If personnel are in the trench is there proper entry and egress?*Ladder, ramp, steps > 4′ Yes No N/A I. Have spoils been placed at a minimum of two feet from the excavation edge?* Yes No N/A J. Have trench inspections been completed and documented?* Yes No N/A K. Has soil type been identified through approved testing methods? (If not considering Type C)*Thumb penetration test; Plasticity test; Penetrometer test; 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 safety interlocks operational?* Yes No N/A D. Are hazard lights working properly?* Yes No N/A E. Are buckets and booms free of cracks and defects?* Yes No N/A F. Are personnel clear of the danger area or working radius?* Yes No N/A G. Are seat belts being utilized while equipment is in operation?* Yes No N/A H. Has the equipment been properly secured for transport?* Yes No N/A I. Has there been a daily inspection on the equipment using the Heavy Equipment Inspection Form?* Yes No N/A J. Have all operators been properly trained on safe use and operation of the unit being used?* 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 all tools in good condition?* Yes No N/A B. Are electrical tools properly grounded or double insulated?* Yes No N/A C. Are proper guards in place?* Yes No N/A D. Are the hand tools free from cracks, damage, and modifications?* Yes No N/A E. Are all tools being used for intended purpose of the manufacturer?* Yes No N/A File Drop files here or Select files Max. file size: 50 MB. Part 17: Climbing Facilities/Portable Ladders* Yes No A. Is the climbing path clear of obstruction?* Yes No N/A B. Is there a safety climb system available?* Yes No N/A C. Does the safety climb system pass inspection?* Yes No N/A D. Are portable ladders at the proper slope? (4:1 ratio)* Yes No N/A E. Is the portable ladder secured, stable, and on level ground?* Yes No N/A F. Does the extension ladder extend 36 inches past landing?* Yes No N/A File Drop files here or Select files Max. file size: 50 MB. Part 18: DOT Vehicles and Drivers* Yes No A. Is CDL valid for equipment being used?* Yes No N/A B. Do drivers have DOT Medical Card (greater than 10,001 lbs GVW)?* Yes No N/A C. Is Electronic Logging Device (ELD) current? (if applicable)* Yes No N/A D. Are Daily Vehicle Inspection Reports (DVIR) current?* Yes No N/A E. Is vehicle labeled per DOT requirements?* Yes No N/A F. Are emergency reflectors in the vehicle?* Yes No N/A G. Is vehicle interior / exterior maintained properly?* Yes No N/A H. Is there any interior or exterior damage?* Yes No N/A I. Is the windshield in good condition?* Yes No N/A J. Are tires in good condition?* Yes No N/A K. Are fire extinguisher(s) of appropriate size and rating readily available and equipped with a current monthly inspection tag?* Yes No N/A L. Is the fire extinguisher location identified?* Yes No N/A M. Is a DOT compliant first aid kit located on the vehicle?* Yes No N/A N. Are all state & federal inspection stickers current?* Yes No N/A O. Is the insurance and registration certificate current and readily available?* Yes No N/A P. Are all exterior lights in operational condition? (truck and trailer)* Yes No N/A Q. Are trailer breakaway harnesses properly functioning?* Yes No N/A R. Are trailer safety chains properly installed?* Yes No N/A S. Is material secured in accordance with DOT regulations?* Yes No N/A T. Are all fuel containers used properly?* Yes No N/A File Drop files here or Select files Max. file size: 50 MB. Overall Impression of VisitOverall 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 Auditor SignatureDate MM slash DD slash YYYY
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