Safety Self Audit Check List Form
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1
2BRIESER CONSTRUCTION COMPANY
SAFETY SELF AUDIT CHECK LIST
ROUTE TO SAFETY MANAGER
ADDITIONAL INFORMATION ON REVERSE SIDE
REV. 111504
THIS CHECK LIST IS A REMINDER ONLY. LOOK FOR OTHER UNSAFE ACTS AND CONDITIONS.
WORK ORDER NO.______________________________
DATE_____________________
TIME _________________
JOB AUDITED: _________________________________
AUDITOR: __________________________________________
JOB FOREMAN: ________________________________
PROJECT MANAGER: ________________________________
YES/NO/N/A
COMMENTS
1) SUPERVISOR ON JOBSITE?
___________
___________________________________
2) PPE BEING WORN AS PER POLICIES?
___________
___________________________________
3) PERMITS AUTHORIZED AND ADHERED TO?
___________
___________________________________
4 ) HAVE ALL PERSONNEL ATTENDED SAFETY TRAINING
___________
___________________________________
5 ) GOOD HOUSEKEEPING PRACTICES BEING FOLLOWED?
A. JOB SITE/FAB AREAS
___________
___________________________________
B. OFFICE/STORAGE AREAS
___________
___________________________________
6) ARE MATERIALS BEING USED PROPERLY VERIFIED?
___________
___________________________________
7) PERSONAL SAFETY EQUIP, I N GOOD CONDITION?
___________
___________________________________
A. FIRST AID SUPPLIES AVAILABLE
___________
___________________________________
B. DRINKING WATER & SANITARY FACILITIES AVAILABLE?
___________
___________________________________
C. FEDERAL, STATE, OSHA & WORK COMP POSTER POSTED? ___________
___________________________________
D. EMERGENCY NUMBERS POSTED
___________
___________________________________
8) CORRECT TOOLS BEING USED FOR THE JOB?
___________
___________________________________
9) TOOLS BEING USED CORRECTLY & IN GOOD REPAIR
___________
___________________________________
10) ELECTRICAL CORD/LIGHTS TAGGED WITH PROPER COLOR? ___________
___________________________________
11) COMPRESSED AIR USED PROPERLY?
___________
___________________________________
12) COMPRESSED GAS CYLINDERS & TORCH USED CORRECTLY? ___________
___________________________________
13) CHAIN HOIST/COMMEALONGS INSPECTED AND TAGGED?
___________
___________________________________
14) JOBSITE ADEQUATELY BARRICADED?
___________
___________________________________
15) TRUCKS AND OTHER MECHANIZED EQUIP. RELIABLE?
___________
___________________________________
16) CONFINED SPACE POLICY ADHERED TO?
___________
___________________________________
17) LOCK OUT TAG OUT POLICY ADHERED TO?
___________
___________________________________
18) EXCAVATION POLICY ADHERED TO?
___________
___________________________________
19) RESPIRATORY POLICY ADHERED TO?
___________
___________________________________
20) HEARING POLICY ADHERED TO?
___________
___________________________________
21) HAZ COM PROGRAM ADHERED TO?
___________
___________________________________
22) LADDER, STAIRWAY SCAFFOLDING POLICY ADHERED TO?
___________
___________________________________
23) FIRE PREVENTENTION POLICY ADHERED TO?
___________
___________________________________
24) MARINE WORK POLICY ADHERED TO?
___________
___________________________________
25) ARE EMPLOYEE'S ATTITUDES CONDUCIVE TO SAFE WORK
PRACTICES?
___________
___________________________________
COMMENTS: _______________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
Brieser Construction
Section 9
Page
9
Safety, Health & Environmental Manual
Jobsite Survey & Behavior Observation
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