2025 Williston Audit

Worksite/Jobsite Audit Form
What Type of Job are you Auditing?*

WarehouseResidentialOilfieldCommercialIndustrialOther
Type of Work Being Audited*

InsulatingScaffoldingPaintingOther
Date*

MonthDayYear
Date
Job Name, Location, or Address*
Audit Completed by*

First NameLast Name
Foreman/Supervisor in Charge of Job*

First NameLast Name
Employee Assisting with Audit

First NameLast Name
Employee Assisting with Audit

First NameLast Name
Description of working being Audited*
S-Satisfactory U- Unsatisfactory, If the field does not apply to your job, leave it blank. Please describe all Unsatisfactory entries.

Emergency Action Plan
Has the Emergency Action Plan been discussed with the crew? Where to go incase of an Emergency, How to get to there, and How to communicate everyone has been accounted for?*

YesNo
Are there 10 or more employees on the Jobsite?*

YesNo
Has a Site Specific Safety Plan been created?*

YesNo
If a Site Safety Plan has not been filled out, please follow the link to complete one.

Click to Fill out the Form

Click to Download the Site Safety Plan pdf
Emergency Action Plan/Site Safety Plan (Picture Upload)

Safety Equipment*

	S	U	Notes
Hard/Bump Hat
Fire Retardant Clothing
Proper Footwear
Hearing Protection
Eye/Face Protection
Gloves Appropriate for job task
Fall Protection
Other:

Documentation Available?*

	S	U	Notes
Required Permits
JHA Complete/Discussed with Entire Crew
Aerial Lift Inspection
Other Inspections
Other:

Worksite Conditions?*

	S	U	Notes
Simultaneous Operations with other contractors
Excavation/Trench
Confined Space
Housekeeping/Clear Pathway
Lockout/Tag out
Fire Extinguisher Needed/Present
Electrical Hazards (GFCI)
Handrail Present
Workstation Setup
Slips, Trips, Falls
Other:

Equipment/Vehicles have Proper Documentation and Operating Properly?

Tools Onsite Being used Properly?*

Elevated Work Procedures Being Followed?

Have employees been trained on the equipment they are operating?(Scissor Lift, Boom Lift, Forklift, etc....)*

YesNoNA (No Equipment used on Jobsite
Elevated Work (Upload up to 5 pictures)

Employees Practicing Proper Body Placement? Employees Exposed to the following?

	S	U	Notes
Correct Body Positioning
Proper Ergonomics
Respiratory Hazard Exposure?
Skin Irritants?
Pre-work Stretching Conducted?
Other:

Weather Affects Your Work?

Worksite/Jobsite Audit Form