Information
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Audit Title
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Document No.
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
Access and Egress
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Hazard Present
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Hazard Details
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Risk Rating 1 High, 2 Medium, 3 Low.
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Hazard Controls
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Action Priorities
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Person Responsible
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Add signature
Warning Devices, Signage, Fences and Barricades
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Hazard Present
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Hazard Details
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Risk Rating 1 High, 2 Medium , 3 Low
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Hazard Controls
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Action Priority
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Person Responsible
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Add signature
House Keeping
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Hazard Present
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Hazard Details
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Risk Rating 1 High, 2 Medium, 3 Low
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Hazard Controls
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Action Priority
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Person Responsible
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Add signature
Hotworks, Screens & Flashback Arrestors
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Hazard Present
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Hazard Details
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Risk Rating
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Hazard Controls
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Action Priority
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Persons Responsible
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Add signature
Penitrations , Covered, Secured, and Identified
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Hazard Present
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Hazard Details
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Risk Rating 1 High, 2 Medium, 3 Low
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Hazard Controls
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Action Priority
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Persons Responsible
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Add signature
Services overhead and Underground
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Hazard Present
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Hazard Details
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Risk Rating 1 High, 2 Medium, 3 Low
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Hazard Controls
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Action Priority
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Persons Responsible
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Add signature
Traffic and Vechicles
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Hazard Present
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Hazard Details
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Risk Rating 1 High, 2 Medium, 3 Low
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Hazard Controls
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Action Priority
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Persons Responsible
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Add signature
PPE
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Hazard Present
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Hazard Details
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Risk Rating 1 High, 2 Medium, 3 Low
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Hazard Controls
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Action Priority
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Persons Responsible
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Add signature
Hazardous Substances, Dangerous Goods and Storage
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Hazard Present
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Hazard Details
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Risk Rating 1 High, 2 Medium, 3 Low
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Hazard Controls
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Action Priority
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Persons Responsible
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Add signature
Confined Spaces
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Hazard Present
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Hazard Details
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Risk Rating 1 High, 2 Medium, 3 Low
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Hazard Controls
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Action Priority
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Persons Responsible
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Add signature
Excavation and Trenches
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Hazard Present
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Hazard Details
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Risk Rating 1 High, 2 Medium, 3 Low
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Hazard Controls
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Action Priority
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Persons Responsible
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Add signature
Overhead Works , Exclusion Zones, Signage and Barricades
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Hazard Present
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Hazard Details
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Risk Rating 1 High, 2 Medium, 3 Low
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Hazard Controls
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Action Priority
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Persons Responsible
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Add signature
Ladders Fit for Purpose and Secure
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Hazard Present
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Hazard Details
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Risk Rating 1 High, 2 Medium, 3 Low
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Hazard Controls
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Action Priority
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Persons Responsible
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Add signature
Scaffold Handover Certificate and Tag
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Hazard Present
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Hazard Details
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Risk Rating 1 High, 2 Medium, 3 Low
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Hazard Controls
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Action Priority
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Persons Responsible
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Add signature
Electrical Testing, Tagging and Mechanical Protection
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Hazard Present
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Hazard Details
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Risk Rating 1 High, 2 Medium, 3 Low
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Hazard Controls
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Action Priority
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Persons Responsible
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Add signature
Plant and Equipment
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Hazard Present
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Hazard Details
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Risk Rating 1 High, 2 Medium, 3 Low
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Hazard Controls
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Action Priority
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Persons Responsible
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Add signature
Lighting , Task and Emergency
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Hazard Present
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Hazard Details
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Risk Rating 1 High, 2 Medium, 3 Low
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Hazard Controls
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Action Priority
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Persons Responsible
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Add signature
Ammenities , Fit for Purpose.
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Hazard Present
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Hazard Details
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Risk Rating 1 High, 2 Medium, 3 Low
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Hazard Controls
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Action Priority
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Persons Responsible
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Add signature
Emergency Equipment, First Aid and Fire
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Alarms Working; Evacuation Plan in Place; Emergency Signage in Place; Fire Fighting System Inspected;
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Hazard Present
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Hazard Details
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Risk Rating 1 High, 2 Medium, 3 Low
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Hazard Controls
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Action Priority
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Persons Responsible
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Persons Responsible
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Add signature
Inspected Completed by
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Add signature
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Select date
Follow Up Inspection Completed By
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Add signature
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Select date
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Hazard Control Implemented
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Hazard Control are Effective