Jobsite Safety/Compliance Audit

Date

Branch

Unit Number*

Rental Equipment Type

Equipment Model Number

Manufacturer

Customer Name

Email

Job Site Name

Job Site Address Line 1

Job Site Address Line 2

Job Site City

Job Site State

Job Site ZIP

Job Site Description

Audit Item Documentation

Annual Inspection Sticker Legible

Yes
No

Annual Inspection Certificate Current or Present

Yes
No

Annual Inspection Cert. Date

Unit Daily Inspection Log Completed

Yes
No

Operator Manual Present

Yes
No

Load Charts Present

Yes
No

Power Lines-Hand Signals-etc. Safety Decals Visible

Yes
No

Job Ticket Signed - Top Signature

Yes
No

Audit Item Safety

Sims Crane Employees Wearing PPE

Yes
No

Other Trades Wearing PPE

Yes
No

Swing Radius Barricaded with Caution Tape

Yes
No

Upper and Lower Fire Extinguisher Present

Yes
No

Fire Extinguisher Charged

Yes
No

Cabs Safety Glass-Windows Intact

Yes
No

CCO or FLT Operator Certified Current

Yes
No

Audit Item DOT-Road Cranes or Support Trucks

Pre and Post Trip Driver Vehicle Insp. Report Complete

Yes
No

Reflectors and Lights Working Properly

Yes
No

Mud Flaps Attached

Yes - Good Condition
No - Poor Condition

Permit Current and Present

Yes
No

Insurance Card Current and Present

Yes
No

Tires Condition

New - Good
Questionable
Poor - Needs Replacement

DOT Annual Inspection Current and Present

Yes
No

DOT Annual Inspection Date

DOT Annual Inspection Sticker Legible

Yes
No

Audit Item Machine Setup and Condition

Wire Rope

Good - New
Questionable
Bad - Needs Replacement

Fluid Leaks

Yes
No

Hook Safety Latch and Gate Safety Latch

Yes - Good
No - Poor

Outriggers Taped Off

Yes
No

Crawlers-Outriggers-Pads-Tires Setup and Condition

Good Condition and Proper Setup
Questionable
Poor Condition or Improper Setup

LMI-ATB-etc. Operator Safety Aids

Yes - Present and Functioning
No - Not Functioning
LMI or ATB NOT Equipped

Mats-Cribbing-Dunnage

Yes - Present and Good Condition
Not Present
Not Adequate or Poor Condition

Machine Level

Yes
No

Audit Item Load Concerns

Is Personnel Lifting Basket in use

Yes
No

Is Personnel Lifting Form in use

Yes
No

Rigging

by Sims
by Customer
by 3rd Party or Others

Signal Method

Verbal Signals
Hand Signals
Mental Telepathy
No Signals Used

Rigging Type

Signal Person Name

Taglines Used

Yes - Adequate
No - Inadequate

Audit Item Hazards

Weather Conditions - check all that apply

Power Lines in Work Area

Yes
No

Location and Distance of Nearest Power Lines

Underground Hazards in Work Area

Yes
No

Underground Hazards Details

Obstacles in Load Path

Yes
No

Obstacles in the Blind

Yes
No

Operator Aware of Hazards

Yes
No

Additional Audit Details

Auditor Name

Operator Name

Customer Safety Contact

Oiler Name

Observations or Comments