Information
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Document No.
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Audit Title
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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
Site Address
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- Spill Potential
- Weather Condition
- MSDS's / Eyewash
- Ventilation / Inhalation
- Heat / Cold Stress
- Other Workers in Area
- Cuts / Sharp Edges
- Inadequate Lighting
- Housekeeping / Hygiene
- Poor Access / Egress
- UV Exposure / Chemical Burns
- Barricades / Guardrails
Person conducting toolbox
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- Instructions Clearly Understood
- Trained to Use Tool and Perform Task
- Distraction in the Work Area
- Working Alone (communications)
- Lift Heavy/Awkward Position
- External Noise Levels / Hearing
- Physical Limitations / Positioning
- Visibility / Accessibility
- Respirator Fit Test
- Reversing Vehicles /Traffic
- Safety Compliance / Signage
- Area Secure / Whipchecks
Topics to cover/discuss
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PPE - proper use & care of hard hats, gloves, safety glasses, masks, gloves
- Instructions Clearly Understood
- Trained to Use Tool and Perform Task
- Distraction in the Work Area
- Working Alone (communications)
- Lift Heavy/Awkward Position
- External Noise Levels / Hearing
- Physical Limitations / Positioning
- Visibility / Accessibility
- Respirator Fit Test
- Reversing Vehicles /Traffic
- Safety Compliance / Signage
- Area Secure / Whipchecks
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SWMS - discuss any issues and proper understanding of swms
- Instructions Clearly Understood
- Trained to Use Tool and Perform Task
- Distraction in the Work Area
- Working Alone (communications)
- Lift Heavy/Awkward Position
- External Noise Levels / Hearing
- Physical Limitations / Positioning
- Visibility / Accessibility
- Respirator Fit Test
- Reversing Vehicles /Traffic
- Safety Compliance / Signage
- Area Secure / Whipchecks
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First Aid & emergency procedures on site
- Instructions Clearly Understood
- Trained to Use Tool and Perform Task
- Distraction in the Work Area
- Working Alone (communications)
- Lift Heavy/Awkward Position
- External Noise Levels / Hearing
- Physical Limitations / Positioning
- Visibility / Accessibility
- Respirator Fit Test
- Reversing Vehicles /Traffic
- Safety Compliance / Signage
- Area Secure / Whipchecks
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Housekeeping - everybody's responsibility to keep a clean and tidy worksite everyday
- Instructions Clearly Understood
- Trained to Use Tool and Perform Task
- Distraction in the Work Area
- Working Alone (communications)
- Lift Heavy/Awkward Position
- External Noise Levels / Hearing
- Physical Limitations / Positioning
- Visibility / Accessibility
- Respirator Fit Test
- Reversing Vehicles /Traffic
- Safety Compliance / Signage
- Area Secure / Whipchecks
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Tools - safe use/handling and care of all tools
- Instructions Clearly Understood
- Trained to Use Tool and Perform Task
- Distraction in the Work Area
- Working Alone (communications)
- Lift Heavy/Awkward Position
- External Noise Levels / Hearing
- Physical Limitations / Positioning
- Visibility / Accessibility
- Respirator Fit Test
- Reversing Vehicles /Traffic
- Safety Compliance / Signage
- Area Secure / Whipchecks
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Site Specific issues
- Instructions Clearly Understood
- Trained to Use Tool and Perform Task
- Distraction in the Work Area
- Working Alone (communications)
- Lift Heavy/Awkward Position
- External Noise Levels / Hearing
- Physical Limitations / Positioning
- Visibility / Accessibility
- Respirator Fit Test
- Reversing Vehicles /Traffic
- Safety Compliance / Signage
- Area Secure / Whipchecks
HAZARDS / CONCERNS ACTION PLAN
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1. Task / Condition
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Hazard
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Control
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2. Task / Condition
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Hazard
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Control
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3. Task / Condition
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Hazard
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Control
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4. Task / Condition
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Hazard
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Control
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5. Task / Condition
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Hazard
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Control
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6. Task / Condition
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Hazard
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Control
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7. Task / Condition
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Hazard
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Control
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8. Task / Condition
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Hazard
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Control
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Names & signatures of all attendees
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Signatures
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