Information

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

Section 1.0 Fall Protection

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  • 1.1 Is fall protection used to prevent fall hazards?<br>Fall Protection Types - Guard rail, Parapet wall, Fall arrest, Fall restraint, or Warning line.

  • 1.2 Are holes covered to prevent falls to lower levels?<br>Holes - Openings larger than 2 inches.

  • 1.3 Are covers used for skylights gates or chains secured in lifts?

  • Note: Take pictures of any fall hazards

  • 1.4 - Performance Measurement (Nominal - 24 points)

Section 2.0 Ladders

  • 2.1 Are ladders secured (top and bottom) and extending 3 ft. above the roof's eave?

  • Note: Take pictures of any ladder hazards

  • 2.2 - Performance Measurement (Nominal - 17 points)

Section 3.0 Personal Protective Equipment (PPE)

  • 3.1 Is PPE worn for work-related hazards?<br>PPE - Hard hats, Safety glasses, Gloves, Long-sleeved shirts, Long pants.

  • 3.2 - Performance Measurement (Nominal - 3 points)

Section 4.0 Electrical

  • 4.1 Are extension cords cut or missing a ground pin?

  • 4.2 Are extension cords plugged into a GFCI?

  • 4.3 - Are there any cuts in the insulation jack that exposes the conductor?

  • Note: Take Picture of Electrical Cord Hazard

  • 4.4 - Performance Measurement (Nominal - 3 points)

Section 5.0 Chemicals and Labeling

  • 5.1 Are labels available on containers?

  • 5.2 Are Safety Data Sheets (SDS) available and on-site for employee review?

  • Note: Take pictures of labeling or chemical hazards

  • 5.3 - Performance Measurement (Nominal - 3 points)

Section 6.0 Fire Protection

  • 6.1 Are fire extinguishers within 25 - 50 ft of work?

  • 6.2 Is the fire extinguishers tagged and ready for use?

  • Note: Take pictures of any Fire Hazard

  • 6.3 - Performance Measurement (Nominal - 8 points)

Section 7.0 Lifting and Above Head Work

  • 7.1 Did you communicate the work schedule with people below your work?

  • 7.2 Does the lifting area have warning lines, a barricade, or spotter?

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  • 7.3 - Performance Measurement (Nominal - 8 points)

Section 8.0 Communication

  • 8.1 Did you communicate a Safety Talk today?

  • 8.2 - Performance Measurement (Nominal - 3 points)

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.