DFS Safety

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Report Date & Time

  Date
• Location
  Address

• Job at Hand

  Yes

  No

  N/A

• Observer's Name

Protective Equipment

• Head Gear

  Safe

  At Risk

  N/A

• Eye Protection

  Safe

  At Risk

  N/A

• Safety Footwear

  Safe

  At Risk

  N/A

• Hearing Protection

  Safe

  At Risk

  N/A

• Fall Protection

• Body Harness

  Yes

  No

  N/A

• Lanyard

  Yes

  No

  N/A

• Reflective Clothing

  Safe

  At Risk

  N/A

• Other

  Safe

  At Risk

  N/A

Tools & Equipment

• First Aid Kit

  Yes

  No

• Is the First Aid Kit Complete

  Yes

  No

• Fire Extinguisher

  Yes

  No

• Is Inspection up to date

  Yes

  No

• Ladders

  Yes

  No

  N/A

• Rigging

  Yes

  No

  N/A

• Tools

  Yes

  No

  N/A

• Guards

  Yes

  No

  N/A

• Barriers

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Vehicle / Hoist Etc.

Truck

• Make, Model, License Plate # ;

• Photo

  Media

• Pre Trip Inspection present?

  Yes

  No

• If yes, add photo or scan in inspection report.

  Media
Forklift

• Make, Model, Unit # ;

• Photo

  Media

• Daily vehicle inspection sheet present?

  Yes

  No

• If yes, add photo or scan in inspection report.

  Media
Manlift

• Make, Model, Unit # ;

• Photo

  Media

• Daily vehicle inspection sheet present?

  Yes

  No

• If yes, add photo or scan in inspection report.

  Media
Bucket Truck

• Make, Model, License Plate # ;

• Photo

  Media

• Pre Trip Inspection present?

  Yes

  No

• If yes, add photo or scan in inspection report.

  Media
Scissor Lift

• Make, Model, Unit # ;

• Photo

  Media

• Daily vehicle inspection sheet present?

  Yes

  No

• If yes, add photo or scan in inspection report.

  Media
Crane

• Make, Model, License Plate # ;

• Photo

  Media

• Daily vehicle inspection sheet present?

  Yes

  No

• If yes, add photo or scan in inspection report.

  Media

• Vehicle Log present?

  Yes

  No

• Other

  Yes

  No

  N/A

General

• Housekeeping

  Yes

  No

  N/A

• Lockout

  Yes

  No

  N/A

• Electrical

  Yes

  No

  N/A

• Power lines

  Yes

  No

  N/A

• Procedures

  Yes

  No

  N/A

• Signage

  Yes

  No

  N/A

• Meeting

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Workers

• Worker(s)

Worker

• Full Name;

• Signature

  Sign

Action Taken

• Praise Worker(s) Performance

• Demonstrate, correct, train

• Reminder Issued Verbally

• Verbal Warning Issued

• Stop Work

• Follow Up / Further action Required

  Yes

  No

  N/A

• Follow Up Supervisor

• Recommendations:

• Observer's Signature

  Sign

• Date

  Date

• Follow-up / Corrective action taken;

• Supervisor's Signature

  Sign

• Date

  Date