Title Page
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Company
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Work Area
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Date
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Supervisor/Lead
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Location
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Team Member Conducting Audit:
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Contractor Being Observed:
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Location:
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Area Being Observed:
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Summery of job Task:
Section to Identify that all PPE, Equipment, and conditions are safe:
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Are eye and or face protection being used?
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Is appropriate respiratory protection used?
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Is appropriate hand protection being used?
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Is appropriate foot protection being used?
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Is appropriate Hearing protection being used?
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Are all Employees wearing FRC's?
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Is fall protection being used?
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Are H2S monitors or 4 gas monitors being used?
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Are JSEA's/SOP's available for reference?
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Are safety meeting/tailgate meetings being held?
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Is training documentation available?
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Are required permits available? (LOTO, Hotwork, Hazardous Work Permit, Etc.)
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Is good housekeeping in place?
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Have any spills been identified?
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Are there any slip trip and falls?
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Are machine guards in place?
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Are cords/hoses in good condition?
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are slings/chains/ropes in good condition?
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Is there an emergency management plan in place?
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Are lifting devices in good condition?
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Have tools been inspected and are being used properly?
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Are fire extinguishers available and inspected?
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Are bonding cables and grounding equipment in place?
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Are workers aware of Stop Work Authority?
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Is a Hazard Communication system in place along with SDS for chemicals on location?
Positive Observations
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Observation Issues
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Observation No. 2
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Observation No. 3
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Additional comments:
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Additional Pictures
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Contractor Signature
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Observer Signature