Site Safety Audit Form JDH Site Safety Audit "*" indicates required fields Date* MM slash DD slash YYYY Department* IN-Fiber IN-Civils IN-Wireless/Tower KY-Vertical Drilling KY-Civils Job #*Project Name/Number*Site Location*Customer*Auditor Name*Foreman*Project Manager*Type of Structure*MonopoleSSTGuyedRooftopWater TankUtility PoleSmall CellOtherScope of Work*Part 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? (Tower only) 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. Are minimum approach distances (MAD) being utilized for overhead power? Yes No N/A I. 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 File Drop files here or Select files Max. 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: Confined Space* Yes No A. Is there a competent person on site? Yes No N/A B. Do employees have documented confined space entry training? Yes No N/A C. Has the confined space been evaluated and hazards identified? Yes No N/A D. Is the confined space permit completed and available on site? Yes No N/A E. Has the atmosphere been tested and within acceptable range? Yes No N/A F. Have attendants and entrants been identified? Yes No N/A G. Is a rescue system (non-entry) being used? Yes No N/A FileMax. file size: 50 MB.Part 19: 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 NameDate MM slash DD slash YYYY Auditor SignatureDate MM slash DD slash YYYY "*" indicates required fields Date* MM slash DD slash YYYY Department* IN-Fiber IN-Civils IN-Wireless/Tower KY-Vertical Drilling KY-Civils Job #*Project Name/Number*Site Location*Customer*Auditor Name*Foreman*Project Manager*Type of Structure*MonopoleSSTGuyedRooftopWater TankUtility PoleSmall CellOtherScope of Work*Part 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? (Tower only) 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. Are minimum approach distances (MAD) being utilized for overhead power? Yes No N/A I. 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 File Drop files here or Select files Max. 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: Confined Space* Yes No A. Is there a competent person on site? Yes No N/A B. Do employees have documented confined space entry training? Yes No N/A C. Has the confined space been evaluated and hazards identified? Yes No N/A D. Is the confined space permit completed and available on site? Yes No N/A E. Has the atmosphere been tested and within acceptable range? Yes No N/A F. Have attendants and entrants been identified? Yes No N/A G. Is a rescue system (non-entry) being used? Yes No N/A FileMax. file size: 50 MB.Part 19: 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 NameDate MM slash DD slash YYYY Auditor SignatureDate MM slash DD slash YYYY