Information
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Audit Title
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Document No.
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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
1. High Risk Process Evaluation - answering yes to any question in this section will require the issue of a specific permit.
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1.1. Is the work area a confined space?
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1.2. Are you undertaking Hot Work (Grinding, Cutting, Welding...)?
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1.3. Are you working on live electricity?
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1.4. Are you working at height (using steps, ladders, platforms, MEWPs....)?
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1.5. Are you working on high pressure air lines?
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1.6. Does the work involve exposure or potential exposure to asbestos.
2. Workplace Hazards
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2.1. Is there free access and exit from the work area?
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2.2. Is access to your work area adequately guarded against unauthorised entry?
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2.3. Is the work area free form any hazard which may cause a slip, trip or fall?
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2.4. Is the work area free from obstructions and projections?
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2.5. Is the work area free from dangers of falling or moving objects?
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2.6. Is there enough room to work safely?
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2.7. Are dangers from traffic adequately controlled
3. Machinery Hazards
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3.1. Has machinery been isolated in such a way that it cannot be inadvertently operated?
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3.2. Have all electrical hazards been safely covered?
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3.3. Can the task be carried out without removing safety devises (guards, interlocks.....)?
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3.4. If not are there safety procedures in place?
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3.5. Are you adequately protected from any moving machinery?
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3.6. Are you protected / isolated from any extremely hot or cold parts of the machine?
4. Personal Exposure Hazards
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4.1. Have all lifting tasks been safely addressed and the required method determined (hoist, 2 man lift......)?
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4.2. Are you protected against noise?
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4.3. Is there adequate lighting available to carry out the task?
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4.4. Are you protected from prolonged exposure to vibration?
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4.5. Is the work area free from exposure to high temperature or humidity?
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4.6. Do you have the correct tools for the task and are they in a good state of repair?
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4.7. Are you protected against any chemical, particles or dust involved in the task?
5. Administrative Controls
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5.1. Do you have the correct personal protective equipment (PPE) for the task?
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5.2. Has the line operator(s) been informed of the work to be undertaken?
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5.3. Are line operator(s) competent for the tasks to be undertaken?
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5.4. Do you have the necessary experience and training to undertake the task?
Corrective Actions
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Enter any corrective actions that will be undertaken
Sign Off
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On site representative
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Auditor's signature