2011 Safety Excellence Award Training
Field Audit Form Review
Houston Business Roundtable
Presented by: Larry McElroy
Safety Audit Form
¨ Current Form. (Revised September 2010)
¨ 11 Page Document.¨ Will be emailed out
and can be found on the HBR website. www.houbrt.com
¨ Use the Form as a Format for your Audit.
Safety Audit Form Sections
28 Sections Audited:
Safety Training EducationHazard Communication ProgramProcess Safety ManagementRespiratory Protection ProgramHearing Conservation ProgramEmergency Evacuation PlanPersonal Protective Equipment Substance Abuse Control ProgramAudit Inspection ProgramBehavioral Based SafetyIncident InvestigationsRecordkeeping Medical / First Aid Program
Work PermitsHouskeepingFire Protection and PreventionEnvironmental ManagementTool/Equipment InspectionsElectrical SafetySign, Signals and BarricadesLPG/Compressed Gases/Flammable LiquidsLaddersScaffoldsExcavationIndustrial Hygiene ProgramWorkforce DevelopmentBest Practices
Accident Prevention Program
Section 1:
ITEM FIELDVERIFIED
COMMENTS SCORE
0 1 2 3 N/A
A. Management Involvement in safety Programs
B. Written Safety PolicyC. Safety policy communicated to and understood by
all employees X
D. Safety and Health ManualE. Written procedures for safety activities (JSA, JHA ,
committee, etc.) X
F. Written operating procedures/work practices X
G. Safety handbook for employees X
ITEM FIELDVERIFIED
COMMENTS SCORE
0 1 2 3 N/AH. Annual safety goals set for continuous
improvement
I. Company safety recognition program in place
J. Company safety representative identifiedK. Safety representative participates in safety
problems/activities
L. Safety representative inspects all jobsites X
M. Disciplinary action programN. Copy of all federal safety and health regulations
available on jobs and/or posted as required XO. Participation in a safety professional association
(Safety Council, ABC, , ASSE, HBR, Etc.)
Section 1: Accident PreventionProgram, cont.
Section 26: Best Practices
ITEM FIELDVERIFIED
COMMENTS SCORE
0 1 2 3 N/A
A. Are Best Practice(s) Fully Implemented at Site X
B. Year to Year Improvement in Site Statistics X
C. OSHA Challenge, VPP, OSHA SHARP, OSHA Star X
Section 26- Best Practices and Year to Year Improvements
¨ Highlight Company Programs that are considered to be the strongholds of your organizations.
¨ Focus on a select few.¨ Emphasize Site and total Company EH&S Statistical Data.
SCORING: For each item listed below, decide if the entry meets the criteria as follows:
Audit Scoring System
Score – 0 (Below Average)¨ No Program in place.
Score – 1 (Average)¨ Program in place and
meets the minimum requirements.
¨ Employees in the field have knowledge of the program.
1 = Average N/A = Not Applicable 0 = Below Average 2 = Above Average 3 = Excellent
SCORING: For each item listed below, decide if the entry meets the criteria as follows:
Audit Scoring System
Score – 2 (Above Average)
¨ The Program is in place and exceeds industrial standards.
¨ Employees in the field are knowledgeable and participation is high.
1 = Average N/A = Not Applicable 0 = Below Average 3 = Excellent2 = Above Average
SCORING: For each item listed below, decide if the entry meets the criteria as follows:
Audit Scoring System
Score – 3 (Excellent)¨ The Program is in
place and exceeds industrial standards.
¨ Employees in the field are knowledgeable and participation is high and exceeds requirements to the extent to where it is recognized as a “Best Practice”.
1 = Average N/A = Not Applicable 0 = Below Average 2 = Above Average 3 = Excellent
SCORING: For each item listed below, decide if the entry meets the criteria as follows:
Audit Scoring System
Score – N/A¨ Should be
checked if it is non applicable.
¨ Is not counted against the overall score.
¨ Calculation is based on an overall percentage.
1 = Average 0 = Below Average 2 = Above Average 3 = ExcellentN/A = Not Applicable
Section 29: Final Score
Section 29- Final Score Each individual page is totaled
for the number of items evaluated and the points scored.
(bottom of each page)
The Sum of the Sub-totals are then divided by the sum of the number of items.
141
385
2.73
Number of Items Evaluated
Subtotal of Score Points
Sections 30-32: Comments and Commitment
• Completed by auditors.
• Importance of Client comments.
• Commitment verified through the audit process.
• Can be the tie breaker section.
ITEM FIELD VERIFIED COMMENTS SCORE
0 1 2 3 N/AWritten Safety Policy:A. CorporateB. Site Xi. Safety policy communicated to and understood by
all employeesX
ii. Safety and Health Manualiii. Written procedures for safety activities (JSA, JHA ,
committee, etc.)X
iv. Written operating procedures Xv. Safety handbook for employees Xvi. Annual safety goals set for continuous improvementvii. Company safety recognition program in placeviii. Company safety representative identifiedix. Safety representative participates in safety
problems/activities
x. Safety representative inspects all jobsites Xxi. Disciplinary action programxii. Copy of all federal safety and health regulations
available on jobs and/or posted as requiredX
xiii. Participation in a Contractor Safety Council
Section 1Accident Prevention Program
1. Accident Prevention ProgramITEM FIELD
VERIFIED COMMENTS SCORE
0 1 2 3 N/A
i. Safety policy communicated to and understood by all employees
X
ii. Safety and Health Manualiii. Written procedures for safety activities (JSA, JHA ,
committee, etc.)X
iv. Written operating procedures Xv. Safety handbook for employees Xvi. Annual safety goals set for continuous improvementvii. Company safety recognition program in placeviii. Company safety representative identifiedix. Safety representative participates in safety
problems/activities
x. Safety representative inspects all jobsites Xxi. Disciplinary action programxii. Copy of all federal safety and health regulations
available on jobs and/or posted as requiredX
xiii. Participation in a Contractor Safety Council
ITEM FIELD VERIFIED COMMENTS SCORE
0 1 2 3 N/A
i. Safety policy communicated to and understood by all employees
X
ii. Safety and Health Manualiii. Written procedures for safety activities (JSA, JHA ,
committee, etc.)X
i. Safety policy communicated to and understood by all employees
X
ii. Safety and Health Manualiii. Written procedures for safety activities (JSA, JHA ,
committee, etc.)X
iv. Written operating procedures Xv. Safety handbook for employees Xvi. Annual safety goals set for continuous improvementvii. Company safety recognition program in placeviii. Company safety representative identifiedix. Safety representative participates in safety
problems/activities
x. Safety representative inspects all jobsites Xxi. Disciplinary action programxii. Copy of all federal safety and health regulations
available on jobs and/or posted as requiredX
xiii. Participation in a Contractor Safety Council
ITEM FIELD VERIFIED COMMENTS SCORE
0 1 2 3 N/AA. Management Involvement in safety ProgramsB. Written Safety Policy XC. Safety policy communicated to and understood by
all employeesX
D. Safety and Health ManualE. Written procedures for safety activities (JSA, JHA ,
committee, etc.)X
F. Written operating procedures XG. Safety handbook for employees XH. Annual safety goals set for continuous improvementI. Company safety recognition program in placeJ. Company safety representative identifiedK. Safety representative participates in safety
problems/activities
L. Safety representative inspects all jobsites XM. Disciplinary action programN. Copy of all federal safety and health regulations
available on jobs and/or posted as requiredX
O. Participation in a Contractor Safety Council
ITEM FIELD VERIFIED COMMENTS SCORE
0 1 2 3 N/AA. Management Involvement in safety ProgramsB. Written Safety Policy XC. Safety policy communicated to and understood by
all employeesX
D. Safety and Health ManualE. Written procedures for safety activities (JSA, JHA ,
committee, etc.)X
F. Written operating procedures XG. Safety handbook for employees XH. Annual safety goals set for continuous improvementI. Company safety recognition program in placeJ. Company safety representative identifiedK. Safety representative participates in safety
problems/activities
L. Safety representative inspects all jobsites XM. Disciplinary action programN. Copy of all federal safety and health regulations
available on jobs and/or posted as requiredX
O. Participation in a Contractor Safety Council
RemovedAddedRemovedRemovedAdded
ITEM FIELDVERIFIED COMMENTS SCORE
0 1 2 3 N/AA. High noise area and operations identification
(Owner or Contractor?)X
B. Hearing protection and records training X
Sections 2 & 6Training and Hearing Protection
2. Safety Training Education
6. Hearing Conservation Program
ITEM FIELDVERIFIED COMMENTS SCORE
0 1 2 3 N/AA. Written new hire orientation XB. Tool box talks/safety meetings XC. Specific safety training for all employees (permits,
vessel entry, etc.)X
D. Safety incidents and activities reviewed with all employees
X
ITEM FIELDVERIFIED COMMENTS SCORE
0 1 2 3 N/AA. Written new hire orientation XB. Tool box talks/safety meetings XC. Specific safety training for all employees (permits,
vessel entry, etc.)X
D. Safety incidents and activities reviewed with all employees
X
E. Skills training for all craft workers X
ITEM FIELDVERIFIED COMMENTS SCORE
0 1 2 3 N/AA. Written new hire orientation XB. Tool box talks/safety meetings XC. Specific safety training for all employees (permits,
vessel entry, etc.)X
D. Safety incidents and activities reviewed with all employees
X
E. Skills training for all craft workers X
ITEM FIELDVERIFIED COMMENTS SCORE
0 1 2 3 N/AA. High noise area and operations identification
(Owner or Contractor?)X
B. Hearing protection and records training XC. Noise Monitoring X
ITEM FIELDVERIFIED COMMENTS SCORE
0 1 2 3 N/AA. High noise area and operations identification
(Owner or Contractor?)X
B. Hearing protection and records training XC. Noise Monitoring X
Removed
Added
ITEM FIELDVERIFIED COMMENTS SCORE
0 1 2 3 N/AA. PPE Assessment/Evaluation
B. Head protection worn by everyone in the designated area and hard hats are in good condition
X
C. Eye/face protection provided and used where operation of machines present potential eye or face injury
X
D. Hearing protection provided where required XE. Approved respiratory protection provided and used
where requiredX
F. Safety harnesses, lifelines and lanyards are provided and used where required
X
Section 8Personal Protective Equipment
B. Head protection worn by everyone in the designated area and hard hats are in good condition
X
C. Eye/face protection provided and used where operation of machines present potential eye or face injury
X
D. Hearing protection provided where required XE. Approved respiratory protection provided and used
where requiredX
F. Safety harnesses, lifelines and lanyards are provided and used where required
X
G. Dress code and minimum PPE standard XH. Safety harness and lanyards meet inspection
requirementsX
ITEM FIELDVERIFIED COMMENTS SCORE
0 1 2 3 N/AA. PPE Assessment/Evaluation
ITEM FIELDVERIFIED COMMENTS SCORE
0 1 2 3 N/AA. PPE Assessment/EvaluationB. Employee provided by EmployerC. Head protection worn by everyone in the designated
area and hard hats are in good conditionX
D. Eye/face protection provided and used where operation of machines present potential eye or face injury
X
E. Hearing protection provided where required XF. Approved respiratory protection provided and used
where requiredX
G. Safety harnesses, lifelines and lanyards are provided and used where required
X
H. Dress code and minimum PPE standard XI. Safety harness and lanyards meet inspection
requirementsX
J. Proper Gloves X
8. Personal Protective EquipmentITEM FIELD
VERIFIED COMMENTS SCORE
0 1 2 3 N/AA. PPE Assessment/EvaluationB. Employee provided by EmployerC. Head protection worn by everyone in the designated
area and hard hats are in good conditionX
D. Eye/face protection provided and used where operation of machines present potential eye or face injury
X
E. Hearing protection provided where required XF. Approved respiratory protection provided and used
where requiredX
G. Safety harnesses, lifelines and lanyards are provided and used where required
X
H. Dress code and minimum PPE standard XI. Safety harness and lanyards meet inspection
requirementsX
J. Proper Gloves XAdded
Added
Sections 10 & 11Audits and BBS
ITEM FIELDVERIFIED COMMENTS SCORE
0 1 2 3 N/AA. Written program in placeB. Employee participation1. Tracked X2. Documented3. Communicated4. Employee Feedback XC. Management involvement and review
ITEM FIELDVERIFIED COMMENTS SCORE
0 1 2 3 N/AA. Written plan/procedure format for conducting safety
audits/inspectionsB. Audit results documentedC. Corrective action implemented and documented XD. Problems and remedies communicated throughout
company
ITEM FIELDVERIFIED COMMENTS SCORE
0 1 2 3 N/AA. Written plan/procedure format for conducting safety
audits/inspectionsB. Audit results documentedC. Corrective action implemented and documented XD. Problems and remedies communicated throughout
companyE. Frequency of Audits
10. Audit Inspection Program
11. Behavioral Based SafetyAdded Section
ITEM FIELDVERIFIED COMMENTS SCORE
0 1 2 3 N/AA. Written plan/procedure format for conducting safety
audits/inspectionsB. Audit results documentedC. Corrective action implemented and documented XD. Problems and remedies communicated throughout
companyE. Frequency of Audits
Added
ITEM FIELDVERIFIED COMMENTS SCORE
0 1 2 3 N/A
A. First-aid supplies X
B. Qualified personnel (first-aid card minimum)/CPR
Section 14Medical/First Aid Program
ITEM FIELDVERIFIED COMMENTS SCORE
0 1 2 3 N/A
A. First-aid supplies X
B. Qualified personnel (first-aid card minimum)/CPR
C. Emergency service set up
D. Emergency telephone numbers posted X
E. Medical personnel available for advice and consultation
F. In compliance with blood borne pathogens standard X
ITEM FIELDVERIFIED COMMENTS SCORE
0 1 2 3 N/A
A. First-aid supplies X
1. Process to manage
2. Process to monitor supply
3. Resource adequate for number of employees on site
B. Qualified personnel (first-aid card minimum)/CPR
C. Emergency service set up
D. Emergency telephone numbers posted X
E. Medical personnel available for advice and consultation
F. In compliance with blood borne pathogens standard X
ITEM FIELDVERIFIED COMMENTS SCORE
0 1 2 3 N/A
A. First-aid supplies X
1. Process to manage
2. Process to monitor supply
3. Resource adequate for number of employees on site
B. Qualified personnel (first-aid card minimum)/CPR
C. Emergency service set up
D. Emergency telephone numbers posted X
E. Medical personnel available for advice and consultation
F. In compliance with blood borne pathogens standard X
14. Medical/First Aid Program
Added
Added
Added
Sections 18 & 20Environmental and Electrical
ITEM FIELDVERIFIED COMMENTS SCORE
0 1 2 3 N/AA. Written Environmental Policy StatementB. Spill Prevention PlanC. Environmental Risk AssessmentD. Communication of Site Environmental ConcernsE. Notification to Owner of leak or upset
ITEM FIELDVERIFIED COMMENTS SCORE
0 1 2 3 N/AA. Written Environmental Policy StatementB. Spill Prevention PlanC. Environmental Risk AssessmentD. Communication of Site Environmental ConcernsE. Notification to Owner of leak or upsetF. Green Initiatives
ITEM FIELDVERIFIED COMMENTS SCORE
0 1 2 3 N/AA. Written assured grounding program/GFCI XB. Electrical tools grounded or double insulated XC. Electrical panels labeled X
ITEM FIELDVERIFIED COMMENTS SCORE
0 1 2 3 N/AA. Written assured grounding program/GFCI XB. Electrical tools grounded or double insulated XC. Electrical panels labeled XD. State licensed/certification/qualified
18. Environmental Management
20. Electrical Safety
ITEM FIELDVERIFIED COMMENTS SCORE
0 1 2 3 N/AA. Written Environmental Policy StatementB. Spill Prevention PlanC. Environmental Risk AssessmentD. Communication of Site Environmental ConcernsE. Notification to Owner of leak or upsetF. Green Initiatives
ITEM FIELDVERIFIED COMMENTS SCORE
0 1 2 3 N/AA. Written assured grounding program/GFCI XB. Electrical tools grounded or double insulated XC. Electrical panels labeled XD. State licensed/certification/qualified
Added
Added
A. Portable electric tools XB. Tools are maintained in safe condition XC. All power operated tools properly guarded XD. Abrasive wheels and tools properly equipped and
used XE. Woodworking tools properly equipped and used XF. Inspection Program XG. Powder actuated tools XH. Powered Industrial Trucks XI. Personnel Baskets XJ. Lifting equipment (come-alongs and chainfalls) XK. Hydraulic cranes XL. Gantry cranes XM. Crawler cranes XN. Overhead hoists XO. Drum hoists XP. Power platforms, aerial lifts, scissor lifts, JLG’s, etc. XQ. Suspension scaffolds X
S. Contractor owned equipment XR. Wire rope/chain/slings X
ITEM FIELD COMMENTS SCORE
0 1 2 3 N/A
Section 19Tools/Equipment Inspections
H. Wire rope/chain/slings, Lifting equipment (come-alongs and chainfalls) X
I. Mobile Equipment (power industrial trucks, man lifts, cranes, fork lifts, ’s X
B. Tool Training in Place X
ITEM FIELDVERIFIED COMMENTS SCORE
0 1 2 3 N/AA. Inspection Program XB. Tool Training in Place XC. Portable electric toolsD. Tools are maintained in safe condition XE. All power operated tools properly guarded XF. Abrasive wheels and tools properly equipped and
used X
G. Powder actuated tools X
H. Wire rope/chain/slings, Lifting equipment (come-alongs and chainfalls) X
I. Mobile Equipment (power industrial trucks, man lifts, cranes, fork lifts, ’s X
19. Tools/Equipment Inspections
Removed
Removed
Removed
Combined
CombinedCombined
Combined
CombinedCombined
CombinedCombinedCombined
Combined
RearrangedAdded
Added
Added
Section 21Signs, Signals, and Barricades
ITEM FIELDVERFIED COMMENTS SCORE
0 1 2 3 N/AA. “Danger" and "Caution" signs available and used to
warn against potential hazards or to caution against unsafe practices
X
B. Safety instructions and directional signs posted where required
X
C. Accident prevention tags available and used where required
X
D. Flagmen used where required X
E. Crane and hoist signals posted and used XF. Barricades provided where needed X
ITEM FIELDVERFIED COMMENTS SCORE
0 1 2 3 N/AA. “Danger" and "Caution" signs available and used to
warn against potential hazards or to caution against unsafe practices
X
B. Safety instructions and directional signs posted where required
X
C. Accident prevention tags available and used where required
X
D. Flagmen used where required X
ITEM FIELDVERFIED COMMENTS SCORE
0 1 2 3 N/AA. “Danger" and "Caution" signs available and used to
warn against potential hazards or to caution against unsafe practices
X
B. Safety instructions and directional signs posted where required
X
C. Accident prevention tags available and used where required
X
D. Flagmen used where required XE. Crane/Signalman Training verifiedF. Crane and hoist signals posted and used XG. Barricades provided where needed X
ITEM FIELDVERFIED COMMENTS SCORE
0 1 2 3 N/AA. “Danger" and "Caution" signs available and used to
warn against potential hazards or to caution against unsafe practices
X
B. Safety instructions and directional signs posted where required
X
C. Accident prevention tags available and used where required
X
D. Flagmen used where required XE. Crane/Signalman Training verifiedF. Crane and hoist signals posted and used XG. Barricades provided where needed X
21. Signs, Signals, and Barricades
Added
Sections 23 & 24Ladders and Scaffolds
ITEM FIELDVERFIED COMMENTS SCORE
0 1 2 3 N/AA. Condition XB. Inspection of XC. Training on proper placement XD. Job made ladders according to standardsE. Retractable devices X
ITEM FIELDVERFIED COMMENTS SCORE
0 1 2 3 N/AA. Condition XB. Inspection of XC. Training on proper placement XD. Job made ladders according to standards
ITEM FIELDVERFIED COMMENTS SCORE
0 1 2 3 N/AA. Condition XB. Inspection of XC. Training on proper placement X
ITEM FIELDVERFIED COMMENTS SCORE
0 1 2 3 N/AA. Condition XB. Inspection of XC. Training on proper placement X
E. Retractable devices X
ITEM FIELDVERFIED COMMENTS SCORE
0 1 2 3 N/AA. Condition XB. Inspection of XC. Training on proper placement XD. Retractable devices X
ITEM FIELDVERIFIED COMMENTS SCORE
0 1 2 3 N/A
B. Training - User, Builder, Competent Person XC. Inspection System/Program X
A. Training - User, Builder, Competent Person XB. Inspection System/Program XC. Fall Protection for Builder XD. Records and Documentation X
ITEM FIELDVERIFIED COMMENTS SCORE
0 1 2 3 N/AA. Written program in placeB. Training - User, Builder, Competent Person XC. Inspection System/Program XD. Fall Protection for Builder XE. Records and Documentation X
ITEM FIELDVERIFIED COMMENTS SCORE
0 1 2 3 N/AA. Written program in placeB. Training - User, Builder, Competent Person XC. Inspection System/Program XD. Fall Protection for Builder XE. Records and Documentation X
23. Ladders
24. Scaffolds
Added
Removed
ITEM FIELDVERIFIED COMMENTS SCORE
0 1 2 3 N/A
B. Pre-dig procedures (Excavation permit)C. Daily inspections by competent person XD. Sloped by classification, A, B, C/or supporting system
determined and utilized according to standardX
Section 25Excavation
A. Pre-dig procedures (Excavation permit)B. Daily inspections by competent person XC. Sloped by classification, A, B, C/or supporting system
determined and utilized according to standardX
D. Trenching requirements, bracing, other safeguards according to standards
X
E. Barricades utilized XF. Competent person Identified X
ITEM FIELDVERIFIED COMMENTS SCORE
0 1 2 3 N/AA. Written Program in placeB. Pre-dig procedures (Excavation permit)C. Daily inspections by competent person XD. Sloped by classification, A, B, C/or supporting system
determined and utilized according to standardX
E. Trenching requirements, bracing, other safeguards according to standards
X
F. Barricades utilized XG. Competent person Identified X
ITEM FIELDVERIFIED COMMENTS SCORE
0 1 2 3 N/AA. Written Program in placeB. Pre-dig procedures (Excavation permit)C. Daily inspections by competent person XD. Sloped by classification, A, B, C/or supporting system
determined and utilized according to standardX
E. Trenching requirements, bracing, other safeguards according to standards
X
F. Barricades utilized XG. Competent person Identified X
25. Excavation
Added
Sections 26 & 27IH Program and Workforce Dev.
ITEM FIELD COMMENTS SCORE0 1 2 3 N/A
A. Asbestos Program XB. Lead Abatement Program XC. Abrasive blasting Program XD. Industrial Hygiene Program X
ITEM FIELDVERIFIED COMMENTS SCORE
0 1 2 3 N/A1. Written program in place X2. Exposure Assessment X3. Periodically monitoring X4. Employee Communication X5. Biological Monitoring
ITEM FIELDVERIFIED COMMENTS SCORE
0 1 2 3 N/AA. Formal Craft Training XB. Craft Written Assessments XC. Skills Upgrade Training XD. Performance Verification XE. Benefits & Improvements XF. Incentives and Motivation X
25. Other26. Industrial Hygiene Program
27. Workforce Development
Removed SectionAdded Section
Added Section
ITEM FIELDVERIFIED COMMENTS SCORE
0 1 2 3 N/AA. Are Best Practice(s) Fully Implemented at Site XB. Year to Year Improvement in Site Statistics X
Section 28Best Practices
ITEM FIELDVERIFIED COMMENTS SCORE
0 1 2 3 N/AA. Are Best Practice(s) Fully Implemented at Site XB. Year to Year Improvement in Site Statistics XC. OSHA Challenge, VPP, OSHA SHARP, OSHA Star X
ITEM FIELDVERIFIED COMMENTS SCORE
0 1 2 3 N/AA. Are Best Practice(s) Fully Implemented at Site XB. Year to Year Improvement in Site Statistics XC. OSHA Challenge, VPP, OSHA SHARP, OSHA Star X
28. Best Practices & Year to Year Improvement
Added
2011 Safety Excellence Award Training
Field Audit Form Review
Houston Business Roundtable