• Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Work Environment and Conditions

  • Housekeeping and Layout

  • Security of equipment

  • Barricades and Signage

  • Environmental Controls


  • Lock-out and Tag-out

  • Work Permits

  • Competence for Task - Is evidence available for Licensing for High Risk Plant and or Certificates of Competency where required

SWMS - Pre Start Checks - MSDS

  • Available

  • Adequate

  • Understood

  • Followed

Tools and Equipment

  • Condition

  • Availability

  • Plant is parked in designated areas / Equipment stored in a safe manner ?

People and Behaviours

  • Are employees Assessing and Re-assessing the area ?

  • Are employees maintaining Eyes on Path whilst moving around the worksite ?

  • Are employees Looking Before Moving ?

  • Are employees selecting appropriate Tools and Equipment and wearing correct PPE ?

  • Are employees keeping Eyes on Hands whilst doing works which could result in injury ?

  • Are employees ensuring they are not placing themselves in Line of Fire ?

  • Are employees Communicating their intent to others ?

  • Are employees using correct manual handling techniques to maintain correct Position and Effort ?

Protection systems

  • Is electrical equipment positioned appropriately with current test and tag ?

  • Are fire extinguishers positioned correctly with clear access and in test and tag ?

  • Are hazardous substances used and stored correctly with MSDS available ?

High Risk Activities

  • Are Confined Space Entries being carried out in accordance with procedural requirements ?

  • Are Trenching activities being carried out in accordance with legislative requirements ?

  • Are activities being carried out On, Over or Near Water being undertaken in a safe manner

  • Are employees using appropriate controls for ascending and descending to and from work areas >2mt

  • Has a Traffic Management Plan been developed for the site/is compliance observable ?


  • Note Positive Observations:


  • Provide a sketch of the area of concern if applicable to support findings



  • Select date

Note* IPad/IPhone Version of Agfab XX XX XX

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.