Tower Safety Audit Form Tower 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* Type of StructureMonopoleSSTGuyedRooftopWater TankUtility PoleSmall CellOtherOther Scope 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?* 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. Is the work site clean of trash?* 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: 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 6: 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. Has the Power Company been notified? (if applicable)* 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 7: Cranes* 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, 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. 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 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 O. 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 (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?* 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 Components* Yes No A. Are all tags on rigging equipment legible?* Yes No N/A B. Is rigging equipment being inspected daily and the inspection documented?* 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 and in good condition?* 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 match the wire rope? (if visible)* 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?* Yes No N/A I. Have spoils been placed at a minimum of two feet from the excavation edge?* 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 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: 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: 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 K. Are all exterior lights in operational condition? (truck and trailer)* Yes No N/A L. A Are trailer breakaway harnesses properly functioning?* Yes No N/A L Are trailer safety chains properly installed?* 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 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 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
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