Title Page

  • Site conducted

  • Conducted on

  • Prepared by

  • Location


    1. Please answer all questions below.
    2. Add Photos in "Media" and Comments in "Add note..." on each question as needed.
    3. Add a Corrective Measure in "Action" . Provide a description, assign to a member, set priority, and due date.
    4. Complete the audit by providing a digital signature.

AED, Medical & First Aid

  • Monthly AED check has been performed by an EMT/ERT member and has been verified that it is fully functional

  • Are first aid supplies available and easily accessible?

  • Are emergency phone numbers posted where they can be found in case of an emergency?

  • Is there a process for notifying an EMT/ERT member posted and updated?

  • Are instructions for transportation of an injured or ill employee such as by ambulance posted?

Compressed Gases

  • Are cylinders stored upright, secured and in a dry, cool area?

  • Are cylinders stored away from electrical connections, flames, sources of ignition and flammable/combustible substances?

  • Are acetylene and propane gas cylinders separated from oxygen by at least 20 feet or by a fire resistant partition when in storage?

  • Are all compressed gas cylinder valve covers in place when the cylinders are not in use?

  • Are all compressed gas cylinders labels clear and legible?

  • Are all compressed gas cylinders free from visual defects?

  • Are compressed gas cylinders moved by a suitable hand truck?

Fire Sprinkler

  • Are fire sprinklers riser (vertical water mains) accessible at all times?

  • Is the area around the fire sprinkler risers kept clean, free from debris and in an orderly manner?

  • Are fire sprinkler risers adequately protected from forklift and other potential damage?

  • Are exterior wall valves, post indicator valves locked in the open position?

  • Are fire department connections (FDC) on the exterior of the building kept accessible at all times?

  • Are fire hydrants on and close by the property accessible at all times? (winter especially)

  • Are items stored in racking and other areas near sprinkler heads at a distance providing at least 18 inches of clearance from the heads.

  • Are fire sprinkler zone maps strategically placed for quick reference? (if applicable)

  • Are fire sprinkler risers marked indicating their respective zone being served? (if applicable)

Hazardous Chemicals

  • Are adequate engineering and protective steps taken to protect employees from chemical exposure hazards? (handling of chemicals during production, or exposure from spills/leaks)

  • Are workers nearby aware of the content of chemical systems and are operating procedures readily available?

  • Is there a safety data sheet readily available for each hazardous substance used or accessed to Fortis via a computer in the area of use?

  • Are all containers labeled, tagged or marked as to their contents? (e.g. vats, storage tanks, drums, bottles)

  • If hazardous waste is stored, are all hazardous waste requirements complied with?

  • Are provisions made for secondary containment of chemicals should a container become punctured and/or damaged?

  • Are provisions made to dam, dike, divert a chemical spill/leak from storm sewers?

  • Are spill kits stocked, identified and readily available for use should a spill occur?

  • Are chemicals stored in an orderly fashion and protected from damage to forklift and other motorized vehicle activity?

  • Is proper PPE being worn by employees involved in the handling of hazardous chemicals?

  • Are decontamination procedures being utilized by employees involved in the use of chemicals prior to removing PPE?

Weld Area

  • Are only authorized and trained employees permitted to use welding, cutting or brazing equipment?

  • Appropriate (and dry) PPE worn: eye, ear, and body?

  • Are the work return leads connected to the work piece?

  • Are cables together, without worn/damaged insulation, protected and connected properly?

  • Area welders using local exhaust system?

  • Are gas cylinders secure, inspected and connected properly?

  • Is work stable and within reach?

  • Is the area clean, traffic areas clear, no clutter, no standing water, no flammable or combustible material in the area?

  • Are protective screens in place to protect others?

Additional Details

  • General Comments and Recommendations


  • Completed By:

  • Signature:

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.