Information

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Lockout, Tagout, Verify

  • Has the facility tailored the written corporate program or does the facility have an LTV written program that is in compliance with company, OSHA and provincial regulations. does the program cover the following areas<br>1. Affected, authorized and qualified employees<br>2. Procedures- LTV, Release from lockout, removal of locks etc<br>3. Gang lockout and extended shutdown<br>4. Approved LOTO equipment<br>5. Equipment specific procedures<br>6. Training requirements<br>7. Random inspections to ensure compliance<br>8. Contractors

  • Does the facility have a comprehensive training program that incorporates hands on training, classroom and interactive (Video, PP, DVD) and demonstrations and training on specific machines. (Have the facility show you their program)

  • Has the facility purchased individually keyed locks for personal protection . All locks must have only 1 key and must be able to withstand all environmental conditions and be of the same size, shape and color.

  • Has the facility purchased equipment danger locks (yellow) and are they being used in conjunction with equipment danger tags, these locks can be keyed alike or different. if the facility wishes to use a different color, they must indicate this in the written program.

  • Has the facility purchased personal danger tags (Red/White)

  • Has the facility purchased equipment danger tags (Yellow/Black)

  • Has the facility purchased extended shutdown tags (Red/Black)

  • Has the facility purchased lockout devices such as hasps, valve covers, circuit breaker lockouts, plug caps etc.

  • Has the facility appointed a lockout team or has a manager or supervisor been assigned to implement this vital procedure plant wide

  • Has the person(s) assigned above become intimately familiar with the company LTV program and government regulations (Question team members, manager)

  • Have all the affected and authorized workers been identified and trained according to company program and local legislation (Check training records, written tests) ensure training includes:<br>1. Purpose and scope<br>2. How to recognize hazardous energy sources<br>3. That pulling fuses is not used in lieu of proper LTV procedures<br>4. Limitations of tags<br>5. When retraining will be conducted<br>6. Process of LOTO<br>7. Release from lockout<br>8. Removal of locks by management<br>9. Gang lockout<br>10. Extended shutdown<br>11. Training on machine specific procedures

  • Have all power source disconnects valves, etc been labelled with voltage, what they contain and what they control

  • Has all equipment requiring LTV procedures been identified

  • Has machine specific procedures been developed for all required equipment

  • Has the facility stopped using control power for LTV, IF THE FACILITY IS STILL USING CONTROL POWER THEY CANNOT RECEIVE A GOLD STAR. examples of control power would be removing key from control panel, lockable e-stops

  • Does the facility have a procedure to remove locks when his/her whereabouts is unknown. Has the facility removed any locks, if so did they document removing the lock if it is required in the written program

  • Does the facility LTV program address contractors, are contractors locking out properly Try to find contractors locking out)

  • Has the facility conducted periodic audits/inspections to rate the effectiveness of their LTV program (These inspections are conducted when workers are actually performing LTV operations)

  • Observe employees who are actually locking out if possible, are they using tags in conjunction with locks IF THE FACILITY IS NOT USING TAGS THEY CANNOT RECEIVE A GOLD STAR.

  • Does the facility have a sustainable program (interview workers and review records, if the auditor discovers that the facility only just begun preparing for the audit recently and cannot produce records that shows it has sustained its program for at least the last 6 months then do not give the facility credit for this item

Life Safety, Fire Protection, Flammable Liquids & Hot Work

  • Has the facility developed and implemented a formal written disaster/crisis management plan. Has the plan been communicated to all employees and outside emergency response services, at a minimum, does it cover<br>1. General (Weather, workplace security, natural disaster etc,<br>2. Medical<br>3. Fire<br>4. hazardous Materials & Rescue

  • Has the facility developed and implemented the following vital written programs<br><br>1. Paintline Manual<br>2. Hot Work program<br>3. Sprinkler impairment policy system<br><br>Review policy for completeness

  • Has the facility implemented training programs for the following programs:<br><br>1. Flammable liquids and gasses<br>2. Hot work permit system<br>3. Emergency action and response<br>4. WHMIS

  • Has the facility purchased the required number of fire blankets and portable fire equipment as described in their manual, in addition has the facility purchased spare portable fire equipment for hot work operations

  • Does the facility have an effective communications system to alert employees of the need to respond, evacuate or take cover in the event of an emergency

  • Has the facility purchased an adequate number of first aid kits, spill response kits/equipment. Is the equipment available and properly stocked, are the first aid kits inspected as per local regulations.

  • Has the facility purchased or acquired hot work permits and sprinkler impairment tags

  • Has the facility purchased non-sparking tools and equipment for use in paint line

  • Has the facility purchased all the required PPE so that workers can perform hot work safely<br><br>1. Welding Helmets and face shields<br>2. Welding hats<br>3. Welding Gloves<br>4. Welding coats

  • Have designated roles and responsibilities been defined for emergency operations and have key meeting locations been established in the event of an emergency to manage the overall incident response

  • Have all employees been trained in emergency action

  • Has the facility performed emergency action drills on all shifts, if so are they documented (False alarms may be counted as annual emergency fire drills)

  • Has the facility posted emergency evacuation routes and shelter routes, are these routes current and identified with signage

  • If hazardous weather is possible does the facility have weather radios, are they monitored on all shifts, are they equipped with an alarm and have battery back up

  • Are there an adequate number of first responders for medical emergencies, spills etc, are they available on all shifts

  • If possible observe employees performing hot work. Are they performing cutting, grinding, welding and/or other types of hot work according to facility policy. In the event the auditor cannot observe hot work, he/she will interview employees who perform hot work to verify they follow proper procedures. Review hot work permits

  • If employees are observed performing hot work are they wearing the proper PPE (Welding mask, helmet, faceshield, gloves, coat)

  • Is equipment that is used for welding burning and cutting operations properly maintained and inspected and tested to ensure the equipment is safe to use

  • Is the facility following all aspects of the sprinkler impairment policy

  • Are employees smoking or performing hot work within 30 feet of a restricted area. if so this is considered a critical failure and the facility will receive a failing score on this section of the audit

  • Has the facility fully implemented a paint line manual and are paint line inspections completed every 30 days

  • are employees following bonding & grounding procedures every time they transfer flammable or combustible liquids, if employees are observed not following bonding and grounding procedures during the audit, this will be deemed a critical failure and the facility will receive a failing score on this section of the audit

  • Is the door between the mix room and paint room self closing, is the door physically propped open, if the door is physically propped open and employees are not actively moving material then the facility will receive a failing score on this section of the audit

  • Are warning signs posted around the paint line and flammable liquid storage area

  • Have all employees that handle, transfer or dispense flammable liquids received training in the facility paint line manual

  • Are flammable liquids stored outside paint line area being stored properly

  • Are flammable gas storage areas orderly, secure and free from recognized hazards

  • Does the facility have a sustainable program, if the auditor discovers that the facility has only begun preparing for the audit and cannot produce records that show sustainability for at least the past 6 months then the facility will not receive credit for this item.

Fall Protection & Prevention

  • Has the facility have a tailored written program that is in compliance with company, OSHA and provincial regulations. Does the program cover the following<br>1. Responsibilities<br>2. Location rules<br>3. Pre-use inspections<br>4. Roof permit system<br>5. Fall arrest systems<br>6. Portable and fixed ladder use and inspections<br>7. Requirements for contractors

  • Does the facility have a comprehensive training program which includes classroom training, written tests, demonstrations and hands on demonstrations

  • Has the facility purchased the required number of portable fall protection equipment (Harness, beam wraps, clamps, retractable life lines etc)

  • Does the facility own or lease any of the following equipment<br>1. Articulating boom lift,<br>2. Scissor lift<br>3. Forklift basket<br><br>If the facility does have any of the above equipment have the operators received mobile equipment training and are there operator proficiencies completed. are employees wearing fall protection according to company policy while operating in or riding in boom lifts or forklift baskets. the use of fall protection in scissor lifts is not required except in Canada and is not normally recommended by the manufacturer.

  • Has a fall protection team been established or has an individual(s) such as a supervisor or manager been assigned to implement these procedures location wide

  • Have the above persons become intimately familiar with company policy and provincial regualtions reguarding fall prevention/ fall protection (Question team memebers)

  • Have all employees who work at heights or who may work at heights received training on the following topics<br><br>1. The nature of fall hazards in their workplace,<br>2. The difference between fall prevention and fall protection<br>3. How to conduct pre-use inspections<br>4. Correct procedures for installing, maintaining, disassembling and inspecting fall protection systems<br>5. Proper anchor points<br>6. Situations when fall protection and prevention are required<br>7. Ladder use<br>8. Ladder inspection<br>9. Roof work<br>10. Rescue and rescue services<br>11. Does the facility audit the effectiveness of the training program (Written tests)

  • Do employees perform pre-use inspections of fall protection equipment (ask employees that wear fall protection as part of their job)

  • Has the facility implemented a roof permit system and has the facility restricted access to their roof (check and review cancelled roof permits)

  • Has the facility conducted a fall assessment, is the fall assessment documented and categorized by risk. Is an abatement plan in place for all high risk activities

  • Has the facility implemented a ladder inspection program (review records)

  • Has the facility implemented a formal inspection program for all portable and stationary fall protection equipment (annual inspections records)

  • Are employees wearing fall protection during work activities that require protection, if any employees are found not wearing the required fall protection equipment while performing work that requires such PPE this will be considered a critical failure and the facility will receive a failing score on this section of the audit.

  • Has the facility conducted an annual review of the fall protection program

  • Has the facility eliminated or controlled 90% of its high risk fall hazards

  • Does the facility have a sustainable program, interview employees and review records. if it is discovered that the facility has only just begun preparing for the audit and cannot produce records for the fall prevention program for at least the last 6 months then they will not receive credit for this item

Confined Spaces

  • Has the facility tailored a written Confined Space Entry program that is in compliance with company, OHSA and provincial regulations, does the program cover the following areas<br><br>1. Responsibilities,<br>2. An up to date inventory of confined spaces,<br>3. A permit system for entry<br>4. Training requirements,<br>5. Retraining requirements,<br>6. Air monitoring procedures including calibration and bump testing,<br>7. Confined Space Hazard assessments<br>8. Confined Space -Safe Job Procedures (SJP)- Entry and Work<br>9. Hot work and sand blasting<br>10. Contractors<br>11. Effectiveness testing<br>12. Audit<br>

  • Has the facility developed a comprehensive training program that incorporates classroom learning, written testing and hands on training with rescue equipment, air monitors and entry equipment. (review training program, training records)

  • Has the facility purchased the following equipment<br><br>1. 4 gas air monitor<br>2. Non-entry rescue equipment<br>3. Ventilation equipment<br>4. Required PPE as outlined in the facility CSE hazard assessment

  • Has the facility developed Lockout, Tagout, Verify procedures for all confined spaces

  • If the facility will be entering confined spaces without using non-entry rescue equipment has the location contracted with a private rescue service or obtained confirmation from local emergency services that they will act as the facility's confined space rescue team. If local emergency services are used does the facility call the local service prior to entry, do they exit the space when rescue becomes unavailable

  • Has the facility established a CSE team or has an individual be appointed to oversee the implementation of this critical program plant wide. are the team member(s) intimately familiar with the CSE written program and local regulations governing confined spaces

  • Have all authorized attendants, entrants, and entry supervisors received training (check training records), have they also completed hands on training with air monitor and rescue equipment

  • Have all non-authorized employees received confined space awareness training

  • Has an inventory of all confined spaces been completed

  • Are all confined spaces labelled with proper signage and inventory number

  • Does the facility have the proper PPE to enter chemical or oil tanks (Tyvek suits, goggles, face shields, nitrile gloves etc)

  • Observe an actual entry if possible, is the facility following company procedures and local regulations

  • Review cancelled permits and checklists, are they properly completed and cancelled

  • Have rescue plans been developed for all location confined spaces

  • Are the employees responsible for non-entry rescue trained and qualified in CPR and First Aid, if not is someone always available in the facility that is trained and certified in CPR & First aid (Check certifications)

  • Has the facility completed a mock rescue within the past 12 months

  • Has an audit of the confined space program been completed within the last 12 months

  • Does the facility have a sustainable program, interview employees and review records, if the auditor discovers the facility has only just begun preparing for the audit and the facility cannot produce records for the confined space program for at least the last 6 months then the facility will not receive credit for this item.

Mobile Equipment

  • Has the facility developed a location specific program that is in compliance with company, OSHA or provincial regulations, does the program cover<br><br>1. Responsibilities,<br>2. Location rules,<br>3. Pre-use inspections<br>4. Operator training and written examinations<br>5. Operator proficiencies for all equipment,<br>6. Mobile Equipment Risk assessment,<br>7. New equipment purchase<br>8. Contractors

  • Has the facility developed a comprehensive training program that includes classroom training, video, written proficiency, and hands on training for all of the locations mobile equipment. the training program should include operating instruction, the difference between industrial trucks and automobiles, controls and instrumentation, engine or motor operation, steering, maneuverability, visibility, attachment adaption, capacity, load stability, pre-use inspections, specific workplace hazards, surface conditions, pedestrian areas and aisles, refueling and recharging

  • Has the facility installed speed limiters on all mobile equipment. the speed limiters must control the speed of the equipment to no more than 10kph without effecting the lifting performance

  • Do all counterbalanced fork trucks have seat belts installed

  • Has a mobile equipment team or has an individual manager or supervisor been appointed to implement mobile equipment procedures facility wide

  • Have the person(s) identified above become intimately familiar with the company mobile equipment program and local regulations

  • Has all current mobile equipment and crane operators received training (inspect training records and proficiency tests)

  • Is retraining being completed according to company policy and/or CSA guidelines

  • Are documented pre-use inspections being completed on all shifts

  • Are employees wearing seat belts while operating mobile equipment (Observe employees, if during the audit a employee is observed operating mobile equipment w/o wearing a seatbelt this is considered a critical failure and the facility will receive a failing score on this section of the audit.)

  • Has the facility completed and documented a mobile equipment risk assessment, does it address items such as unprotected gas trains, electrical equipment, offices that can open into ME aisles, blind corners, loading docks, etc

  • Has the facility implemented a procedure to address loading/unloading at loading docks

  • During audit, where all observed employees operating mobile equipment in accordance with policy/legislation (Driving with vision obstructed, transporting gas bottles on forks, operating without pre-shift inspection etc)

  • Has the facility established crane isolation procedures (multiple cranes in a runway, LTV or crane stops)

  • Who performs crane repairs (only qualified persons with specialized training may perform overhead crane repairs)

  • has the facility established a PM program for all mobile equipment and cranes

  • Is a qualified in-house person or 3rd party conducting documented periodic crane inspections (monthly or annually)

  • Has the facility conducted an annual review of the mobile equipment program

  • Does the facility have a sustainable program, (interview employees and check records, if the auditor discovers the facility has only begun preparing for the audit and cannot produce records for at least the last 6 months then they will not get credit for this item)

Machine Guarding

  • Has the facility developed and implemented a written program that complies with company policy and local HS regulations

  • Has the facility developed a comprehensive training program that incorporates classroom training, hands on training and video demonstrations

  • Has the facility developed a documented pre-use inspection program for machine guarding

  • Has a machine guarding team been established or has a supervisor or manager been appointed to oversee the implementation of the program facility wide

  • Have the identified person(s) above become intimately familiar with the company machine guarding program and local regulations concerning guarding

  • Has a facility wide machine guarding risk assessment been conducted, is the assessment documented, does it document the process of hazard elimination

  • Does the facility have mechanical power presses, has the facility established a power press inspection program, are the inspections documented and completed on a regular basis

  • have all the affected employees received training on the machine guarding program

  • Has the facility established a standard guarding system that complies with Federal, State, Provincial, Local regulations

  • Does the facility have a policy or work rules that address long hair, jewellery and loose clothing (review policy)

  • Has an annual review of the machine guarding program been completed

  • Has 90% of the high risk machine guarding hazards been abated (abatement of high risk hazards cannot rely on human intervention)

  • Does the facility have a sustainable program (review records, interview employees, the facility must be able to produce records for at least the last 6 months or they will not receive credit for this item)

Compressors & Gas Cylinders

  • Does the facility have a procedure for delivery, receiving, storage and return of empty cylinders and is it being followed (check shipping/receiving documents and storage areas)

  • Are cylinders clearly marked and identify contents (Check random selection of cylinders)

  • Are cylinders stored in an area protected from external heat sources such as flames, radiant heat, electric arcs or high temperature lines

  • Are cylinders stored or located in an area where they will not be damaged or tampered with by unauthorized persons and are empty/ full cylinders stored separately and properly labelled (check storage facility, ensure items are secured and not at risk to mobile equipment traffic)

  • Are cylinders transported in a manner that prevents them from creating a hazard by tipping, falling or rolling

  • Are cylinders containing liquified gas stored or transported so that the safety relief device are always in direct contact with the vapor spaces in the cylinder

  • Are valve protectors always placed on cylinders when not in use (check stored cylinders)

  • Are all valves closed off before cylinders are moved, when they are empty and at end of job(Check empty assorted cylinders, observe job practices)

  • Are low pressure fuel gas cylinders checked periodically for corrosion, general distortion, cracks or other defects that may indicate weakness or render them unfit for service

  • Does the above check include an inspection of the bottom of each cylinder (ask employee to demonstrate a tank inspection, observe job practices)

  • Do all compressors over 10 HP have the operators manual or is it readily available to employees

Hand, Power Tools & Equipment

  • Do all tools and equipment appear to be in good working order (check random tools)

  • Are hand tools such as chisels and punches that may develop mushroom heads reconditioned or replaced as required

  • Is there a documented replacement procedure in place that tracks tools and equipment repairs (check work orders/purchase orders)

  • Is equipment that is awaiting repairs tagged

  • Is equipment repaired/serviced by competent people

  • Are all cords, plugs free from nicks and cuts or obvious damage (inspect random tools, paying particular attention to areas covered by tape)

  • Are all tool handles firmly attached to heads of all tools

  • Are tool cutting edges kept sharp (Sharp tools will cut smoothly w/o binding or skipping)

  • Is there a tool inventory, is it current within 90 days

  • Are chainsaws in use, if so is there an adequate chainsaw safety program and have affected employees received training

  • Are all power cords in good condition, ensure no double adapters are in use

  • Is the facility using GFI's on all temporary electrical 15, 20, 25, 30 ampere circuits

  • Does the facility have a documented PM program for hand and power tools

  • Do all grinders, saws and similar equipment have appropriate guards in place

  • Are all power cords removed when not in use

  • Are all electrical power tools grounded and double insulated

  • If portable fans are in use are the openings 1/2" or less

  • Are pneumatic and hydraulic hoses checked for damage prior to use

  • Are all portable tools equipped with manufacturer supplied guards

General Work Environment

  • Does the facility have posted in a place visible to employees the following<br><br>1. Company safety policy( Must be signed and dated within 1 year from date of audit),<br>2. Provincial OHS Act or comparable OHSA Regulations,<br>3. Names and work locations of JOHSC Members<br>4. Emergency contact list<br>5. Names and work locations of Facility first aid staff<br>6. Provincial Workers Compensation information<br>7. Recent JOHSC inspections and JOHSC meeting minutes

  • Are all aisle ways clear of obstructions, is there adequate waste containers

  • Are kitchen facilities clean, adequately stocked, floor clean and dry

  • Are washrooms clean, adequately stocked and floors clean and dry

  • Are filing areas organized so that file drawers do not open into walkways, heaviest items in lowest drawers, nothing stored on top of cabinets

  • Are photocopy, fax, mail areas clean and tidy with bins for waste, cords positioned so they do not present trip hazards, adequate space for workers

  • Does the facility have a system in place for entry/exit control, is it in use and is it effective

  • Is there a policy and procedure in place for employees working alone or during off hours

  • Is the facility free from outstanding enforcement orders (Ministry of Labour, Ministry of Environment, OSHA, CVOR etc)

  • Have all supervisors and managers received training in due diligence, company OHS manual, OHS legislation, Workplace Violence and Harassment (Check training logs, interview employees)

  • Have all employees received training in the company OHS manual (Check training logs, interview employees)

Personal Protective Equipment

  • Has the facility completed a hazard assessment for job tasks, is it documented and communicated, does it contain the following:<br><br>1. PPE selection based on job hazard assessment,<br>2. Use, care, replacement of PPE<br>3. Facility minimum PPE requirements

  • Is eye and face protection proper for the tasks being performed

  • Are side protectors in use where there is a risk of flying objects

  • Are filter lenses available where work involves injurious radiant light

  • Are hard hats in use where there is a danger of head injury from falling objects

  • Where there is a risk of side impact are hard hats fitted with side impact protection

  • Where there is a danger of exposure to electrical conductors are hard hats class A or B

  • Has the facility restricted the use of bump caps

  • Does the facility PPE program ensure that safety footwear meets CSA standards for puncture, electrical and crush hazards

  • Is there a policy in place to ensure worn/defective footwear is replaced

  • Is the level of hand protection in use appropriate to the hazards observed during audit

  • Is proper PPE available to workers for all tasks (hot work, welding, cutting etc), is it being worn

  • If employees are required to direct or spot for traffic are reflective vests worn

  • Is PPE maintained as per manufacturers instructions

Industrial Hygiene

  • Is a noise monitoring program in place, are areas with high noise levels identified with proper signage

  • Has the facility identified equipment that produces noise greater than 85db

  • Are engineering controls in place or considered to reduce noise levels, is there a variety of hearing protection available to employees and is it being used when required

  • Do all employees who work/ may work in high noise areas receive audiometric testing annually

  • Do all new employees who work in/may work in high noise areas receive a baseline audiogram within 90 days of hire

  • Do employees who are leaving the company and who may have been exposed to high levels of noise receive an audiogram prior to exiting company

  • Do all employees receive hearing conservation training and is the training documented

  • Is the program reviewed on an annual basis and are the recommendations acted upon

  • Does the facility have a respiratory protection program in place

  • Do all employees who are required to wear respiratory protection receive fit testing and is it documented

  • Do all employees who are required to wear respiratory protection undergo annual pulmonary function tests and are these tests documented

  • Has the facility reduced or eliminated the use of dusk masks

  • During the audit was proper respiratory protection being used for the job tasks observed (if any)

  • Does the facility have in place a policy to restrict eating/drinking around machines and other equipment, chemical storage areas, garbage collection areas and other hazardous areas, is it being enforced

  • Does the facility have in place a pre-employment medical program that covers hearing, physical demands, vision, PFT and job based medical assessments

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.