• Audit Title

  • Document No.

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Lone Worker

  • Office notified and aware of return time

  • Mobile phone available

  • Other

Personal Protective Equipment

  • Hearing protection used

  • Safety boots used

  • Safety eye wear used

  • Hard hats worn

  • Safety vest worn and zipped up

  • Gloves used

  • Other

Manual Handling

  • Team lifting undertaken where applicable

  • Lifting equipment used

  • Manual Handling Training completed

  • Lightweight equipment used

  • Other

Dangerous Goods/Hazardous Substances

  • MSDS available and understood

  • SWMS relating to use prepared and understood

  • Safety eye wear worn

  • Half mask respirator worn

  • Gloves worn

  • Other


  • Sunhat worn

  • Sunscreen

  • Sunglasses worn

  • Shelter from weather

  • Wet weather gear

  • Gumboots worn

  • Long sleeves worn

  • Other


  • Awareness of snakes/spiders/insects (refer to IRD-16, Guidelines for outdoor safety)

  • Gloves worn

  • Spider/insect repellent

  • Other


  • Vehicle hazard lights

  • Witches hats

  • Safety vest worn

  • Parked in designated location/parking spot

  • Other


  • Pedestrian warning signs

  • Site taped off

  • Other

Slips, Trips and Falls

  • Access to area via safest route, avoiding wet, muddy areas taken

  • Area kept clean and tidy

  • Other

Confined Space Associated

  • Permit

  • Permit number

  • Gas detector calibration expiry date

  • Call in process to OCC

  • Other

Plant & Equipment

  • Awareness of plant in vicinity

  • Tools & Equipment checked

  • Hard hats worn in vicinity of plant

  • Other

Other Works in Vicinity

  • Awareness of other works in vicinity which may have an impact

  • Contact made with others to ensure they are aware of you

  • Other

Electrical Cabinets

  • Understanding of what can and cannot be handled within

  • Call in process to OCC advising that access is required

  • Other

Fall from Heights

  • Barricades in position

  • Fall arrest harness used

  • Lad Safe system used

  • Lad Safe/harness system certified/current

  • Second person required

  • Gas detector used - opening wet well/MH

  • Fall protection device located in manhole

  • Other

Sign off

  • Are there other hazards?

  • If yes, what are they?

  • Is the job safe to proceed (if no, notify supervisor immediately)

  • Are all risks and controls communicated to attending personnel?

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  • Notes

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.