Information

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Section I: General Workspace

  • Building cleanliness (Trash removed, equipment and floor clean, items stored neatly)

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  • Signage (caution, warning, no smoking, exit signs, properly affixed to identify hazards)

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  • Egress (clear of obstructions, free access, doors operate freely)

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  • Equipment/Machinery (Secure/Safe to use, machine guards/panels securely in place)

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  • Tools (Properly cleaned/ stored, free of defects, safety features working/ labeled CBRE)

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  • Safety Station (Proper PPE available, good condition, supplies are stocked and inventoried)

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  • Ladders (Good condition/ non-conductive, properly stored/secured, inspected monthly or prior to use/log available,<br> labeled CBRE

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  • Oil Rag Can (Accessible, used only for rags with oil or flammable properties, void of excess rags, laundered weekly)

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  • Confined Space (Plan available, locations identified, signage of locations)

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  • Compressed Gasses (Proper storage location, properly secured, caps on and tight)

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  • Fall Protection (Proper and adequate PPE, inspected monthly or prior to use/log available)

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  • Areas of High Noise (Signage posted, Proper and adequate PPE available)

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  • Overall Average Score for General Workspace:

Section II: Safety Training

  • Safety Training Current for all Staff (attached CBRE Foundation Training Report)

  • First Aid Training (100% Staff is exct and 70% is Poor)

  • Safety Bulletin Boards (Available, current postings, current newsletter posted)

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  • Monthly Safety Meetings (Verify Minutes are maintained, signed)

  • Bloodborne Pathogen Training (Annual training, signed acknowledgements)

  • Storm water Management (Annual Training, signed Acknowledgement)

  • Spill Containment (Annual training, signed acknowledgements)

  • Universal Waste Disposal (Annual training, signed acknowledgements)

  • HazCom (Annual training, signed acknowledgements)

  • Hot Work (Annual training signed acknowledgements)

  • Illness/ Injury Reporting (Annual training, signed acknowledgements)

  • Compressed Gas Mgmt (Annual training, signed acknowledgements)

  • Confined Spaces (Annual Training, signed acknowledgements)

  • Fall Protection (Annual training, signed acknowledgements)

  • Lockout/ Tagout (Annual training, signed acknowledgments)

  • EHS Plan (Schedule of EHS Plan review available, signed acknowledgements are current)

  • Overall Average Score for Safety Training:

Section III: Documentation

  • EHS Policies (IF PRINTED: copies must be current, complete, organized in a book, accessible with signed acknowledgements. IF ELECTRONIC: Staff must be able to locate the newest version on HSE Share Point site, print policies if asked by a regulatory agency or auditor and retain signed acknowledgements

  • CBRE HSE Handbook (IF PRINTED: copies available to all staff. IF ELECTRONIC: Staff must be able to locate the Handbook on the HSE Share Point site, and print if asked by staff/regulatory agency/ auditor)

  • Licenses (All licenses properly displayed, copies on file, easily accessible)

  • Permits (Verify all required permits are posted and compliant)

  • Hot Work Permits (Properly filled out, completed, filed in an organized manner)

  • MSDS (Master Chemical List/MSDSs current, complete & organized, easily accessible, archived MSDSs kept 25 years)

  • Emergency Evacuation Plan (Current, posted, easily accessible, staff knows evacuation accumulation area and their duties during an evacuation)

  • Injury Reporting Plan (Site-specific plan available to all staff, adequate forms available)

  • Emergency Response Plan (Site-specific plan available to all staff)

  • OSHA 300A (Posted Feb 1st thru April 30th, signed copy retained for 5 years)

  • Spill Reporting Plan (Plan available, accurate, acknowledged)

  • SOP: Generator Exercise (Plan available, accurate, acknowledged)

  • SOP: Fire Pump Exercise (Plan available, accurate, acknowledged)

  • Overall Average Score for Documentation:

Section IV: Electrical

  • Electrical Rooms (Clean, organized, no flammables stored in room or within 25' of any electrical panel)

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  • Electrical Distribution (Panel covers installed, 36" clearance in front of each Panel)

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  • Arc Flash (Arc Flash survey complete, proper labels attached to all distribution equipment)

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  • Arc Flash Kit (Adequate amount of arc flash PPE on hand, good condition, properly stored)

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  • Electrical Gloves (Adequate amount of gloves, current test, free of defects)

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  • Extension and portable electrical equipment cords are inspected for torn insulation and missing grounding conductors

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  • Overall Average Score for Electrical:

Section V: Refrigerant Management

  • Site Refrigerant Program Manager:

  • CBRE Chief Engineer Monthly Audit (Records complete and current)

  • CBRE Major Ref. Equip. Form (Records complete and current)

  • CBRE Major Equip. Ref. Usage Log (Records complete and current)

  • CBRE Ref. Cylinder Inventory Log (Records complete and current)

  • CBRE Monthly Refrigerant Report (Records complete and current)

  • CBRE EPA Section 608 Tech. Roster (Records complete and current)

  • CBRE Energy Manager Ref. Program Compliance Grade:

  • Overall Average Score for Refrigerant Management Program:

Section VI: Diesel Fuel Management

  • Diesel Fuel Reporting (Fuel receipts are distributed to CBRE Senior Energy Manager on a monthly basis, receipts are organized and filed at the site)

  • Diesel Fuel Management (Three years of records showing purchase, quantity, amount per piece of equipment)

Section VII: Fire & Life Safety

  • Fire Extinguisher Annual Training (Proof of current training for all staff)

  • Standpipe Inspection (Inspection tags current, marked with MM/DD/YY and initials format)

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  • Fire Extinguishers (Inspection tags current, marked with MM/DD/YY and initials format)

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  • Generator Testing (Copies of monthly, semi-annual and annual tests, retain 2 years)

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  • Fire Pump Testing ( Copies of weekly/monthly and annual flow test, retain 2 years)

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  • Fire Doors (Copies of annual report, retain 5 years)

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  • Sprinkler & Smoke Detection Testing (Copies of all annual reports, signed, retain 5 years)

  • Fume Hood (Copies of all testing reports, signed, retain 2 years, training)

  • Kitchen Hood Testing/ Cleaning (Copies of all testing reports, retain 2 years, training)

  • Overall Average Score for Fire & Life Safety:

Section VIII: Chemical Management

  • HP Prohibited Chemicals (List located in all MSDS books)

  • Chemical Labeling (Verify all chemical containers are properly labeled)

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  • Chemical Disposal (Review site-specific plan, verify we are in compliance)

  • Flammable Cabinet (Accessible, proper cabinet, flammables properly stored)

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  • Corrosives Cabinet (Accessible, proper cabinet, corrosives properly stored)

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  • Spill Kits (In close proximity to all chemical storage, sized properly for spill)

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  • Overall Average Score for Chemical Management:

Section IX: First Aid

  • First Aid Kit (Adequate quantity, properly stocked, ready available to all staff)

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  • Eyewash Stations (Located properly, adequate signage, current PM, signed tag)

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  • Hazard assessments (on file for where PPE must be worn and the types that must be worn)

  • Overall Average Score for First Aid:

Section X: LOTO

  • Assigned Locks & Tags (Each staff has at least one lock/tag, identifiable and all keys)

  • Communal Locks (Available, complete, one key per lock only)

  • Lockout Devices (Adequate supply of various devices used for lockout, per facility req.)

  • Overall Average Score for LOTO:

Section XI: Employee Interview

  • Elevator Entrapment (Explain your role in the event of an elevator entrapment)

  • MSDS (Randomly choose a site chemical, employee must locate MSDS)

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  • Lockout (Employee presents lock and key and explains when to use Lockout and Tagout)

  • Injury Reporting (Employee describes injury reporting plan and where to locate forms)

  • Safety Plan Documentation (Employee shows inspector where all documentation is located)

  • PPE (Employee describes PPE available to them and when they use it)

  • Safety Plans (Random) (Ask employee to explain two randomly selected written plans)

  • Lifting (Employee demonstrates proper way to lift a box from the floor)

  • Spill Kit (Employee shows where the spill kit, identifies content, and describes when to use it)

  • Overall Average Score for Employee Intervies:

Section XII: Scorecard Averages

  • Section I: General Workplace

  • Section II: Safety Training

  • Section III: Documentation

  • Section IV: Electrical

  • Section V: Refrigerant Management

  • Section VI: Diesel Fuel Management

  • Section VII: Fire & Life Safety

  • Section VIII: Chemical Management

  • Section IX: First Aid

  • Section X: LOTO

  • Section XI: Employee Interview

  • Overall Average Site Score:

Inspection Verfication

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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.