Chemical related site visit

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Self Assessment

• Is it safe to exit my vehicle

  Yes

  No

  N/A

• Is the site secure and safe to enter

  Yes

  No

  N/A

• Am I wearing the correct PPE

  Yes

  No

  N/A

• Am I inducted to this site

  Yes

  No

  N/A

• Is effective fencing or demarcation in place

  Yes

  No

  N/A

• Is access control effective

  Yes

  No

  N/A

• Is there a "Sign in and out" system in place

  Yes

  No

  N/A

• Are "No Entry" sign/s in place

  Yes

  No

  N/A

• Are "Danger" signs in place

  Yes

  No

  N/A

• Is Risk Register Board in place

  Yes

  No

  N/A

• Is Risk Register Board information current

  Yes

  No

  N/A

• Are contamination hazard signs in place

  Yes

  No

  N/A

• Is fire extinguisher on site

  Yes

  No

  N/A

• Is complete first aid kit on site

  Yes

  No

  N/A

• Is emergency plan available

  Yes

  No

  N/A

• Are emergency contacts available

  Yes

  No

  N/A

• Is SSSP available on site

  Yes

  No

  N/A

• Is SSSP content known to all working on site

  Yes

  No

  N/A

• Is SSSP in daily use

  Yes

  No

  N/A

• Are contaminated materials wrapped as required

  Yes

  No

  N/A

• Are contaminated materials damaged beyond use

  Yes

  No

  N/A

• Are contaminated materials stored in a lined bin

  Yes

  No

  N/A

• Are bins removed daily

  Yes

  No

  N/A

• No contaminated materials not stored in a bin

  Yes

  No

  N/A

• Has the power supply been isolated

  Yes

  No

  N/A

• Was isolation achieved in acceptable method

  Fuse at pole

  Main supply disconnect at box

  Main supply disconnect at inside box

• Was the isolation completed by a certified electrician

  Yes

  No

  N/A

• Has power supply box been tagged for isolation

  Yes

  No

  N/A

• Is contact details and name of electrician on tag

  Yes

  No

  N/A

• Have fittings, switches and sockets been removed

  Yes

  No

  N/A

• Have wires been capped

  Yes

  No

  N/A

• Has lead based paint been tested for on windows

  Yes

  No

  N/A

• Does paint need to be removed

  Yes

  No

  N/A

• Is paint being removed by appropriate paint stripper

  Yes

  No

  N/A

• Is paint shaving being disposed of correctly

  Yes

  No

  N/A

• Is PPE requirements known on site

  Yes

  No

  N/A

• Is correct PPE being used by all working on site

  Yes

  No

  N/A

• Is replacement PPE available on site

  Yes

  No

  N/A

• No additional notes to make

  Yes

  No

  N/A