Title Page

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Daily Work Summary

  • What type(s) of work are being performed today? Select all that apply.

  • What do you expect to achieve by the end of the day?

  • Any issues or concerns?

  • What plant do you have on site? Identity HIRED in items where these are known.

  • VISITORS-any expected today or to report from yesterday? (Provide reason and outcome)

  • DELIVERIES / COLLECTIONS - (record all movement from yesterday)

Today's Task Breakdown

  • Break today's work into individual step-by-step-tasks below. Assess each task for hazards and controls

  • Work Task
  • Describe this task

  • What category does this task fall under?

  • Select potential hazards that may be encountered while completing this task today.

  • Describe the other potential hazards that may be encountered while completing this task today.

  • What categories of hazard control will you apply to this task?

  • What specific controls will you apply to the above hazards for this task?

  • Describe any other specific controls will you apply to the above hazards for this task.

Final Checks

  • Does every member of the on-duty crew have adequate and appropriate PPE for today's work tasks?

Crew Sign Off

  • Each present team member to sign name and signature acknowledging the above tasks, hazards and controls.

  • Team Member
  • Name & Signature

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