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
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Personnel being inspected:
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Description of work being performed:
1. General
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1.1. Job site hazard analysis completed and on site?
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1.2. Other applicable company safety reporting and accounting documents on site?
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1.3. Personnel are knowledgeable and properly trained on all aspects of work conducted?
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1.4. Work site is clean and free of dangerous waste and materials?
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1.5. Excess/scrap materials are removed or stacked in orderly fashion?
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1.6. Trash and combustible materials are placed in containers designed for that purpose?
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1.7. Work areas have sufficient lighting?
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1.8. Work areas have sufficient ventilation?
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1.9. Holes and openings are protected and marked appropriately?
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1.10. Fire escape exits/routes are clearly identified?
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1.11. Personnel are familiar with their locations?
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1.12. Where 'hot' work is performed, fire extinguisher is located within 100' of work area?
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1.13. Job site has sufficient amenities? (toilets, wash areas, lunch rooms, etc)
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Additional comments:
2. Working at Heights
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2.1. Fall risks of 2m or more?
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2.2. Personnel working above 2M are protected by guardrail, personal fall arrest system, or safety net?
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If not, why not?
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What steps must be taken to provide adequate protection?
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2.3. Unsafe or incomplete edge protection?
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Additional comments:
3. Scaffolds
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3.1. Unlicensed persons erecting scaffold above 4m?
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3.2. Unsafe or incomplete scaffold?
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3.3. Lack of inspection protocol for scaffold?
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3.4. Incompatible scaffold components?
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3.5. Safe Work Load (SWL) exceeded? (tools, stored materials, number of persons)
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Additional comments:
4. Harness and Equipment
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4.1. Unsafe or damaged harness or equipment?
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4.2. Incompatible hooks/equipment?
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4.3. Missing labels?
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4.4. Unsafe or uncertified anchor points?
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4.5. Lack of inspection protocol for equipment?
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4.6. Lack of or inadequate formal training for operators?
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Additional comments:
5. Ladders
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5.1. Unsafe or damaged ladders?
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5.2. Unsafe positioning of ladders?
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5.3. Ladder not properly secured?
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5.4. Ladder unsuitable for job? (e.g. metal ladder used for electrical work)
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5.5 All original labels intact, legible? (ratings and warnings)
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Additional comments:
6. Hazardous Chemical (including fuel and oil)
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6.1. Any hazardous chemicals required for work tasks?
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List chemicals:
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6.2. Any chemicals stored on job site by employees of this organization?
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List chemicals:
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6.3. Unsafe storage location? (e.g. flammables near ignition sources, spills could enter stormwater drains, etc)
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6.4. Incompatible chemicals stored near each other?
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6.5. Inadequate spill containment equipment?
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6.6. Safety Data Sheets not accessible on site?
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6.7. Lack of emergency procedures for injury/spills/fire etc?
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6.8. Excessive quantities stored on site or in vehicles?
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6.9. Insufficient ventilation?
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6.10. Insufficient, or incorrect, PPE?
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6.11. Unsuitable storage containers? (unlabeled or stored in food containers)
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6.12. Chemicals used or stored in or near work area by customer/third party present hazard?
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Additional comments:
7. Electrical Hazards
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7.1. Unsafe electrical test equipment leads? (damaged, out of test date or untested)
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7.2. Lack of Residual Current Device protection? (GFCI, etc)
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7.3. Contact with underground assets?
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7.4. Contact with overhead electrical lines?
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7.5. Overloading outlets?
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7.6. Electrical equipment near water?
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7.7. Electrical equipment near flammables?
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7.8. Electrical equipment near chemicals that could cause damage?
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7.9. Lack of Lock-out/tag-out (LOTO) procedures for electrical equipment?
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7.10. Lock-out/tag-out procedure correctly followed?
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7.11. Energized electrical work permit completed?
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7.12. Electrical cords not cut, damaged?
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7.13. Electrical cords are not used for hoisting or carrying tools and equipment?
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7.14. Energized electrical work permit completed?
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Additional comments:
8. Hand and Power Tools
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8.1. Hand and power tools in good working order?
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8.2. Guards, gauges, and other protective devices in place and free of damage? (saws, drills, pneumatic tools, etc.)
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8.3. Tools stored in secure, dry area?
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8.4. Personnel properly trained on the use of assigned tools?
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Additional comments:
9. Job Site Vehicles
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9.1. Aerial lifts used on job site?
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List types:
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9.2. All tags and warnings in place and legible?
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9.3. Operator's manual maintained on equipment?
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9.4. Only authorized licensed personnel operating equipment?
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9.5. Equipment inspection completed prior to use by authorized operator?
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9.6. Aerial lifts operated/positioned on level even surfaces?
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9.7. Adequate controls to protect personnel/non-workers from hazard exposure? (flag gets, ground guides, barriers, etc.)
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Additional comments:
10. Personal Protective Equipment (PPE)
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List all PPE required for work being performed:
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10.1. Personnel correctly utilize all required PPE?
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10.2. Lack of, or inadequate PPE (including sun protection)
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10.3. Lack of training in safe use, clean-up and inspection of PPE?
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10.4. Overall, personnel are adequately protected?
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List all deficiencies:
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Additional comments:
11. Emergency Response
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NOTE: When applicable, this organization follows procedures implemented by client or general contractor.
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11.1. Lack of, or no emergency plans for site?
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11.2. Emergency procedures not displayed at site?
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11.3. Lack of training and rehearsal of emergency plans?
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11.4. Lack of, or inadequate first aid kits aid equipment for site?
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11.5. Insufficient access to formally trained First Aiders for all shifts?
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11.6. Unsuitable or inadequate communication equipment?
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Additional comments:
12. Administrative Procedures
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12.1. Lack of/or inadequate Site Safety Plan?
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12.2. Failure to obtain permits (Council, EPA, WHS, also Hot Works, Confined Space etc)
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12.3. Lack of, or inadequate, induction for workers, contractors, visitors?
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12.4. Lack or, or inadequate, supervisory arrangements?
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12.5. Lack of/or inadequate training, licenses, skills, experience?
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12.6. Lack of/or inadequate Safe Work Method Statements (SWSM) for high- risk work?
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Additional comments:
13. Personally Assigned Work Truck
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13.1. Safety belts in good repair and used?
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13.2. Windows and mirrors in good repair?
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13.3. Tires (including spare) in good repair and properly inflated?
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13.4. Last oil change exceeded mileage/time requirements?
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13.5. Fire extinguisher present in vehicle?
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13.6. Warning triangles present in vehicle?
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13.7. Registration, insurance forms, and accident report forms present in vehicle?
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List all deficiencies by license number:
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Additional comments:
Corrective Actions
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Enter any corrective actions that will be undertaken
Sign Off
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On site representative
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Auditor's signature
