Title Page
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Audit Title
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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
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Are lockout tagout procedures in place and in use when required? Is there a lockout tagout kit including locks and tags available for use?
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Was a 5x5 conducted and what was it? List the answer below.<br>
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Are all work sites adequately illuminated?
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Are safety data sheets on site and available to employees?
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Is fall protection provided and in use when required?
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Are pits, floor openings and holes covered or otherwise guarded?
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Are safety gloves (ANSI Cut level 4) used on site and as required while performing work?
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Are hard hats or bump caps provided and in use as required? <br>
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Are safety glasses and face shields (or goggles) on site and used when necessary?<br>
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Are safety vests or high visibility shirts used on site and used when necessary?
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Are all work sites clean, sanitary and orderly?
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Are walking and working surfaces properly guarded when exposure to fall is present?
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Are all extension cords in good condition, properly grounded, equipped with ground plugs, and used for temporary applications?
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Are all ladders free from defects, properly labeled, approved and used as intended?
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Are all tools and equipment used by employees in good condition?
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Are employees aware of the hazards caused by fault or improperly used hand tools?
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Is personal protective equipment inspected and in good condition?
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Is protection against the affects of occupational noise exposure provided and used?
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Signature of the Manager or Supervisor responsible for the site location.
