Information

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Documentation

  • Permits in place and signed off

  • JSA completed and signed by all

  • Take 5 completed regularly

  • Personal danger tags correctly completed and are in use

Permit to Work Systems

  • All isolation points are tagged and locked out

  • Confined space work area is correctly established

  • Hot work area is correctly established

  • Working at heights work group is correctly established

  • Required spotters are allocated and in use

Position of People

  • Avoid lines of fire, crush points, entrapment, sparks and drop zones

  • Tag lines are in use

  • Correct manual handling techniques are used

  • Three points of contact is used for access and egress

Tools and Equipment

  • Correct tool being used for the job

  • Tools and equipment are in good working condition

  • Equipment has current electrical inspection tag

  • Rigging equipment has current inspection tag

  • Portable electrical equipment are protected by RCDs

  • Electrical plugs, sockets and leads are all in good condition and off the ground

Plant and Machinery

  • Pre-start log books are being completed

  • Operator of equipment is competent and qualified

  • Operator of equipment has completed VOC

  • Flashing lights, headlights and indicators are working and in good condition

  • Seat belts are in good condition and being worn

  • Windows are clean

  • Records of maintenance and repairs are all kept and available

  • Capacity charts and operators manuals are legible and as per the manufacturers specifications

  • Work is organized for the safety of the operators and others within the same work area

Housekeeping and Area Conditions

  • Work areas are clean and tidy

  • Barricades, barriers and drop zones are in place, stable and in good condition

  • Information tags are attached to barricades, barriers and drop zones

  • Communication means between between workers are being used (eg; two way radios etc.)

  • Floors and surfaces are level and stable

  • Walkways are free from hazards, leads, hoses etc.

  • Guard rails, hand rails and other guards are in place

Environmental

  • Hazardous materials are being store correctly

  • Hazardous materials are being disposed of correctly

  • Spills are contained and cleaned up correctly and efficiently

  • Waste segregation and suitable bin allocation is being used

  • Dust within the work area is being controlled adequately

  • Noise within the work area is being controlled adequately

  • MSDSs are available for materials being used and attached to JHAs

  • Decanted containers have name, risk and safety instructions on label

  • Persons using chemicals have been given adequate instructions and information

PPE

  • Hard hats are being worn and in good condition

  • Safety glasses/goggles are being worn

  • Face masks/shields are being worn

  • Double face protection is being utilised

  • Respirators are being worn and suitable for works being completed

  • Gloves are being worn and suitable for works being completed

  • Hi-visibility long sleeve shirts and pants are being worn and in good condition

  • Steel cap boots are being worn

  • UV protection is being worn for works being conducted outdoors (eg; hard hat brim, sunscreen)

Actions

  • Corrective Actions

  • Notes

  • Add signature

  • Add signature

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.