Site Safety Audit Report Step 1 of 5 20% Date(Required)MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Employee Name(Required) First Last Vehicle Number(Required) Auditor Name(Required) First Last Location/Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code TruckIs the interior clean?(Required) Yes No N/A CommentsIs the exterior clean?(Required) Yes No N/A CommentsIs the truck bed clean/organized?(Required) Yes No N/A CommentsAre tools/paint stored properly?(Required) Yes No N/A CommentsNotable damage to any part of the truck?(Required) Yes No N/A CommentsAll glass free from cracks/obstructions?(Required) Yes No N/A CommentsAre decals in good shape?(Required) Yes No N/A CommentsAre strobe lights all functional and in use?(Required) Yes No N/A CommentsVehicle Registration and proof of insurance?(Required) Yes No N/A Comments PPEDoes task require hard hat?(Required) Yes No N/A CommentsIs employee wearing safety toed boots?(Required) Yes No N/A CommentsDoes task require gloves?(Required) Yes No N/A CommentsDoes current task require safety eyewear?(Required) Yes No N/A CommentsDoes task require Class 3 Vest?(Required) Yes No N/A CommentsAny specialty tools required for task?(Required) Yes No N/A Comments Site Set-UpAre traffic cones placed properly?(Required) Yes No N/A CommentsTruck parked in the safest available location?(Required) Yes No N/A CommentsIs the truck obstructing vehicle or pedestrian traffic flow?(Required) Yes No N/A Comments ItemFire Extinguisher with current inspection?(Required) Yes No N/A CommentsWell stocked First-Aid kit?(Required) Yes No N/A CommentsFirst-Aid and Extinguisher location identified?(Required) Yes No N/A CommentsUtility Hit-Kit?(Required) Yes No N/A CommentsCircle of safety cone in use?(Required) Yes No N/A CommentsAudit RemarksDoes this truck need supplies restocked and/or replaced?
