Information

  • Audit Title

  • Site

  • Location
  • Auditor(s)

  • Division

  • Date

  • Site Operating?

OBSERVATION AREAS: In the areas audited with no deficiencies found, indicate behavior / condition OBSERVED (OB). If the behavior / condition REQUIRES ATTENTION, indicate (RA), and rank most likely result of the problem behavior / condition. Please provide narrative regarding the areas you audit and your findings. If an audited area showed no deficiencies or had notable positive aspects, please state so. Describe the observation and employee interview. What improvement need was identified and understanding made to achieve it? Did other areas for improvement come out of the interview? Operational management and/or the Safety Dept will determine target dates, responsibility and if further investigation or corrective action is required.

  • 1. Pre-operation inspection completed

  • Rank Findings

  • 2. Entering / exiting safely (3-points)

  • Rank Findings

  • 3. Lifting / carrying materials or tools

  • Rank Findings

  • 4. Proper use of tools / equipment

  • Rank Findings

  • 5. Safe condition of equipment / tools

  • Rank Findings

  • 6. Slip / trip avoidance, walkways kept clear

  • Rank Findings

  • 7. Housekeeping and access maintained

  • Rank Findings

  • 8. PPE condition / compliance

  • Rank Findings

  • 9. Safe positions of employees

  • Rank Findings

  • 10. Safe procedures followed

  • Rank Findings

  • 11. Safe procedures established

  • Rank Findings

  • 12. Safe equipment operation (forward)

  • Rank Findings

  • 13. Safe backing practices used

  • Rank Findings

  • 14. Training & knowledge of tasks

  • Rank Findings

  • 15. Railing / guarding compliance

  • Rank Findings

  • 16. LO / TO confined space

  • Rank Findings

  • 17. Traffic control adequate

  • Rank Findings

  • 18. Fall hazards controlled

  • Rank Findings

  • 19. Electrical maintenance / labels

  • Rank Findings

  • 20. Other

  • Rank Findings

Conclusion

  • Who is the responsible manager for any findings in this audit?

  • Site Manager Signature

  • Auditor(s) Signature

  • Date and time completed?

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