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Safety Audit Form

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Equipment Audit Form

Safety Audit Form

Equipment Audit Form

Select Location

Layout

Conducted by: *

Email *

Date *

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Equipment # *

Operator *

General Safety

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1. Task Training (Operator) *

Yes
No

Comments/Corrective Action

Layout

2. Daily Equipment Inspection Completed and Documented *

Yes
No

Comments/Corrective Action

Layout

3. Operator's Manual Available in Cab of Equipment *

Yes
No

Comments/Corrective Action

Layout

4. Fire Extinguisher Available and Properly Tagged *

Yes
No

Comments/Corrective Action

Layout

5. First Aid Kit Available and properly stocked *

Yes
No

Comments/Corrective Action

Layout

6. Lighted Buggy Whip and/or Beacon *

Yes
No

Comments/Corrective Action

Layout

7. LOTO Procedures in Place Operator Understands When and Where to Use. *

Yes
No

Comments/Corrective Action

From The Ground

Layout

1. Tires, Wheels, Lug Nuts, Stem, Caps *

Yes
No

Comments/Corrective Action

Layout

2. Bucket, Cutting Edge (if equipped) *

Yes
No

Comments/Corrective Action

Layout

3. All Hydraulic Cylinders *

Yes
No

Comments/Corrective Action

Layout

4. Equip. Frame/Arms *

Yes
No

Comments/Corrective Action

Layout

5. Transmission, Transfer Case *

Yes
No

Comments/Corrective Action

Layout

6. Fuel Tank *

Yes
No

Comments/Corrective Action

Layout

7. Hydraulic Tank *

Yes
No

Comments/Corrective Action

Layout

8. Air Tank *

Yes
No

Comments/Corrective Action

Layout

9. Axles *

Yes
No

Comments/Corrective Action

Layout

10. Differential *

Yes
No

Comments/Corrective Action

Layout

11. Lights (Front, Rear, Work) *

Yes
No

Comments/Corrective Action

Layout

12. Battery Cables/Terminals *

Yes
No

Comments/Corrective Action

Layout

13. Chain Drive/Adjustment (if equipped) *

Yes
No

Comments/Corrective Action

Layout

14. Hi-Rail Gear (if equipped) *

Yes
No

Comments/Corrective Action

Layout

15. Equip. Components Greased Regularly (grease fittings) *

Yes
No

Comments/Corrective Action

Engine Compartment

Layout

1. Engine Oil *

Yes
No

Comments/Corrective Action

Layout

2. Engine Coolant *

Yes
No

Comments/Corrective Action

Layout

3. Radiator *

Yes
No

Comments/Corrective Action

Layout

4. All Hoses *

Yes
No

Comments/Corrective Action

Layout

5. Fuel Filter/Water Separator *

Yes
No

Comments/Corrective Action

Layout

6. All Belts *

Yes
No

Comments/Corrective Action

Layout

7. Air Filters *

Yes
No

Comments/Corrective Action

Layout

8. Overall Engine Compartment *

Yes
No

Comments/Corrective Action

Outside the Cab

Layout

1. Steps and Handrails *

Yes
No

Comments/Corrective Action

Layout

2. Roll Over Protection (ROPS) *

Yes
No

Comments/Corrective Action

Layout

3. Windshield/Windows *

Yes
No

Comments/Corrective Action

Layout

4. Windshield Wipers/Washers *

Yes
No

Comments/Corrective Action

Layout

5. Doors/Door Latches *

Yes
No

Comments/Corrective Action

Layout

6. Overall Outside condition *

Yes
No

Comments/Corrective Action

Inside the Cab

Layout

1. Seat/Seatbelts and Mounting *

Yes
No

Comments/Corrective Action

Layout

2. Horn, Backup Alarm, Lights *

Yes
No

Comments/Corrective Action

Layout

3. Mirrors Clean and Properly Adjusted *

Yes
No

Comments/Corrective Action

Layout

4. Cab Air Filter (if equipped) *

Yes
No

Comments/Corrective Action

Layout

5. Gauges, Indicators, Switches Controls *

Yes
No

Comments/Corrective Action

Layout

6. Housekeeping *

Yes
No

Comments/Corrective Action

Layout

7. Overall Cab Interior *

Yes
No

Comments/Corrective Action

Additional Comments

Safety Audit Form

Select Location

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Conducted by: *

Email *

Date *

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Crew *

Foreman *

Location *

Job Briefing/On Shift Inspection

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1. Job Briefing filled out *

Yes
No

Comments/Corrective Action

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2. On Shift Inspection completed (book filled out) *

Yes
No

Comments/Corrective Action

Layout

3. Work assignments reviewed *

Yes
No

Comments/Corrective Action

Layout

4. Work procedures discussed *

Yes
No

Comments/Corrective Action

Layout

5. Tools/Equipment reviewed *

Yes
No

Comments/Corrective Action

Layout

6. Job Hazards discussed *

Yes
No

Comments/Corrective Action

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7. First Aid & CPR trained person on site *

Yes
No

Comments/Corrective Action

Layout

8. On/Off Track Safety Procedures in place (red flags, etc.) *

Yes
No

Comments/Corrective Action

Layout

9. Lockout/Tagout Procedures in place if necessary *

Yes
No

Comments/Corrective Action

Layout

10. Personal locks available *

Yes
No

Comments/Corrective Action

PPE

Layout

1. Hard hats *

Yes
No

Comments/Corrective Action

Layout

2. Safety glasses *

Yes
No

Comments/Corrective Action

Layout

3. Safety toe boots/metatarsals *

Yes
No

Comments/Corrective Action

Layout

4. Safety vests / Shirts *

Yes
No

Comments/Corrective Action

Layout

5. Gloves *

Yes
No

Comments/Corrective Action

Layout

6. Hearing Protection available (being used) *

Yes
No

Comments/Corrective Action

Additional PPE (As necessary)

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1. Face shields/screens *

Yes
No

Comments/Corrective Action

Layout

2. Leg Protectors (Cutting) *

Yes
No

Comments/Corrective Action

Layout

3. Arm sleeves *

Yes
No

Comments/Corrective Action

HazCom

Layout

1. Chemicals properly stored *

Yes
No

Comments/Corrective Action

Layout

2. Approved containers *

Yes
No

Comments/Corrective Action

Layout

3. Containers properly labeled *

Yes
No

Comments/Corrective Action

Layout

4. SDS's available *

Yes
No

Comments/Corrective Action

Power Tools

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1. Power Unit *

Yes
No

Comments/Corrective Action

Layout

2. Rail Saw *

Yes
No

Comments/Corrective Action

Layout

3. Rail Drill *

Yes
No

Comments/Corrective Action

Layout

4. Impact Wrench *

Yes
No

Comments/Corrective Action

Layout

5. Spiker *

Yes
No

Comments/Corrective Action

Layout

6. Spike Puller *

Yes
No

Comments/Corrective Action

Layout

7. Tie Drill *

Yes
No

Comments/Corrective Action

Layout

8. Hand Tamper *

Yes
No

Comments/Corrective Action

Layout

9. Jackhammer *

Yes
No

Comments/Corrective Action

Layout

10. Grinder *

Yes
No

Comments/Corrective Action

Layout

11. Leafblower *

Yes
No

Comments/Corrective Action

Layout

12. Weed eater *

Yes
No

Comments/Corrective Action

Layout

13. Hydraulic Hoses *

Yes
No

Comments/Corrective Action

Hand Tools

Layout

1. Spike Mauls *

Yes
No

Comments/Corrective Action

Layout

2. Sledge Hammers *

Yes
No

Comments/Corrective Action

Layout

3. Claw Bars *

Yes
No

Comments/Corrective Action

Layout

4. Lining Bars *

Yes
No

Comments/Corrective Action

Layout

5. Spike Lifters *

Yes
No

Comments/Corrective Action

Layout

6. Bolt Punches *

Yes
No

Comments/Corrective Action

Layout

7. Rail Wedges *

Yes
No

Comments/Corrective Action

Layout

8. Track Wrenches *

Yes
No

Comments/Corrective Action

Layout

9. Tie Tongs *

Yes
No

Comments/Corrective Action

Layout

10. Picks *

Yes
No

Comments/Corrective Action

Layout

11. Shovels *

Yes
No

Comments/Corrective Action

Layout

12. Drift pins *

Yes
No

Comments/Corrective Action

Layout

13. Rail Dogs (equip.) *

Yes
No

Comments/Corrective Action

Layout

14. Crescent wrenches *

Yes
No

Comments/Corrective Action

Layout

15. Track Jacks *

Yes
No

Comments/Corrective Action

Welding/Cutting

Layout

1. Welding Hoods *

Yes
No

Comments/Corrective Action

Layout

2. Face Shields *

Yes
No

Comments/Corrective Action

Layout

3. Goggles *

Yes
No

Comments/Corrective Action

Layout

4. Respirators *

Yes
No

Comments/Corrective Action

Layout

5. Oxygen/Acetylene properly stored *

Yes
No

Comments/Corrective Action

Layout

6. Gauges in proper working condition *

Yes
No

Comments/Corrective Action

Layout

7. Welding/cutting shields in place *

Yes
No

Comments/Corrective Action

Electrical

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1. Trigger locks removed *

Yes
No

Comments/Corrective Action

Layout

2. Electrical inspection completed (properly coded) *

Yes
No

Comments/Corrective Action

Layout

3. Extension cords in good condition *

Yes
No

Comments/Corrective Action

Layout

4. Generator *

Yes
No

Comments/Corrective Action

Vehicle/Equipment #

Layout

1. Daily Pre-op completed *

Yes
No

Comments/Corrective Action

Layout

2. Seat Belts in use *

Yes
No

Comments/Corrective Action

Layout

3. Fire Extinguisher available and properly tagged *

Yes
No

Comments/Corrective Action

Layout

4. First Aid Kit available *

Yes
No

Comments/Corrective Action

Layout

5. Horn/backup alarm *

Yes
No

Comments/Corrective Action

Layout

6. Lights/turn signals working *

Yes
No

Comments/Corrective Action

Layout

7. Windows in good condition *

Yes
No

Comments/Corrective Action

Layout

8. Lighted buggy whip *

Yes
No

Comments/Corrective Action

Layout

9. Doors/latches working properly *

Yes
No

Comments/Corrective Action

Layout

10. Brakes functioning properly *

Yes
No

Comments/Corrective Action

Layout

11. Tires in good condition *

Yes
No

Comments/Corrective Action

Layout

12. Wheels chocked. *

Yes
No

Comments/Corrective Action

Layout

13. Proper housekeeping *

Yes
No

Comments/Corrective Action

Layout

14. Overall condition *

Yes
No

Comments/Corrective Action

Tool Trailer/Trailer #

Layout

1. Tools/Equipment properly stored *

Yes
No

Comments/Corrective Action

Layout

2. First Aid Kit available *

Yes
No

Comments/Corrective Action

Layout

3. Fire Extinguisher available and properly tagged *

Yes
No

Comments/Corrective Action

Layout

4. Chemicals properly stored *

Yes
No

Comments/Corrective Action

Layout

5. Approved containers/ properly labeled *

Yes
No

Comments/Corrective Action

Layout

6. Drinking water available *

Yes
No

Comments/Corrective Action

Layout

7. Doors/latches working properly *

Yes
No

Comments/Corrective Action

Layout

8. Lights/turn signals working *

Yes
No

Comments/Corrective Action

Layout

9. Tires in good condition *

Yes
No

Comments/Corrective Action

Layout

10. Hitch cables, plugs, chains *

Yes
No

Comments/Corrective Action

Layout

11. Proper housekeeping *

Yes
No

Comments/Corrective Action

Layout

12. Overall trailer condition *

Yes
No

Comments/Corrective Action

Additional Comments

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Address

HEADQUARTERS
3950 Fossil Creek Boulevard, Suite 106
Fort Worth, TX 76137

Contact

(817) 439-5693

Email

info@americantrack.com