Title Page
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Document No.
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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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Enter inspectors name here
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I. Accident Reporting
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First Aid Logs are in use and accurate?
- yes
- no
- N/A
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If answer was "no" what is the correction date
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Near misses are reported and on file
- Yes
- No
- N/A
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If answer was "no" what is the correction date
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Accidents are being reported promptly - no lag time
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If answer was "no" what is the correction date
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Property damage is reported promptly and accurately
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If answer was "no" what is the correction date
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II. Sprains and Strains
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Good body mechanics during lifting tasks
- Yes
- No
- N/A
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If answer was "no" what is the correction date
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Forces to lift, push, carry < 50#
- Yes
- No
- N/A
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If answer was "no" what is the correction date
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Awkward postures are avoided when possible
- Yes
- No
- N/A
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If answer was "no" what is the correction date
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III. Material Handling
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Round stock is racked, banded or chocked
- Yes
- No
- N/A
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If answer was "no" what is the correction date
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Material is stored flat not Leaning i.e. Pallets
- Yes
- No
- N/A
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If answer was "no" what is the correction date
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Stacks of material are sturdy without fall hazard
- Yes
- No
- N/A
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If answer was "no" what is the correction date
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Arms length noted while moving material stacks
- Yes
- No
- N/A
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If answer was "no" what is the correction date
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Slings are several inches from end of beams
- Yes
- No
- N/A
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If answer was "no" what is the correction date
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IV. Cranes and Rigging
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Push buttons labeled
- Yes
- No
- N/A
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If answer was "no" what is the correction date
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No exposed wires
- Yes
- No
- N/A
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If answer was "no" what is the correction date
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Safety latches working
- Yes
- No
- N/A
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If answer was "no" what is the correction date
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Crane hooks inspected, wire rope unfrayed
- Yes
- No
- N/A
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If answer was "no" what is the correction date
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Cranes in use without shock loading
- Yes
- No
- N/A
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If answer was "no" what is the correction date
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Material lifted/moved is within load capacity
- Yes
- No
- N/A
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If answer was "no" what is the correction date
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Crane hooks insulated during welding
- Yes
- No
- N/A
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If answer was "no" what is the correction date
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Slings, hooks, grabs in safe condition
- Yes
- No
- N/A
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If answer was "no" what is the correction date
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Hands and body positions are safe during C & R work
- Yes
- No
- N/A
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If answer was "no" what is the correction date
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Plate clamps are being used correctly
- Yes
- No
- N/A
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If answer was "no" what is the correction date
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V. Building and Fire Codes
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Extinguishers, aisles, and exits are clear / unblocked?
- yes
- no
- N/A
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If answer was "no" what is the correction date
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Access to circuits, fuse and electrical panels are clear?
- yes
- no
- N/A
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If answer was "no" what is the correction date
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Fire extinguishers ready and inspected in past year?
- yes
- no
- N/A
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If answer was "no" what is the correction date
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Painting is done 25' away from hot work?
- yes
- no
- N/A
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If answer was "no" what is the correction date
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Hot work permit visible in coatings?
- yes
- no
- N/A
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If answer was "no" what is the correction date
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VI. Electrical
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Electrical repair performed by authorized personnel?
- yes
- no
- N/A
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If answer was "no" what is the correction date
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No visible or exposed wires?
- yes
- no
- N/A
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If answer was "no" what is the correction date
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Extension cords not in use as permanent wiring?
- yes
- no
- N/A
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If answer was "no" what is the correction date
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Lock and Tag hardware visible during machine maint.?
- yes
- no
- N/A
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If answer was "no" what is the correction date
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Machine & EE flooring is dry during operations?
- yes
- no
- N/A
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If answer was "no" what is the correction date
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Are ground prongs intact?
- yes
- no
- N/A
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If answer was "no" what is the correction date
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Paint pumps and containers are grounded / bonded?
- yes
- no
- N/A
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If answer was "no" what is the correction date
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VII. Chemical Safety
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Clothing and PPE prevent skin and eye exposure?
- yes
- no
- N/A
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If answer was "no" what is the correction date
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Clothing is free from wet chemical saturation?
- yes
- no
- N/A
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If answer was "no" what is the correction date
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Safety Data Sheets available and accessible?
- yes
- no
- N/A
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If answer was "no" what is the correction date
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Drums and containers contents are labeled?
- yes
- no
- N/A
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If answer was "no" what is the correction date
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Labels have been supplied?
- yes
- no
- N/A
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If answer was "no" what is the correction date
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Are areas free from fluid spills, hoses, trip hazards?
- yes
- no
- N/A
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If answer was "no" what is the correction date
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VIII. PPE / Respirators
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Respirator barrier and face are free from facial hair?
- yes
- no
- N/A
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If answer was "no" what is the correction date
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Employee # on the respirators in the shop?
- yes
- no
- N/A
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If answer was "no" what is the correction date
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Cartridges have service date in writing?
- yes
- no
- N/A
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If answer was "no" what is the correction date
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Cartridge has < 30 days of service life?
- yes
- no
- N/A
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If answer was "no" what is the correction date
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Respirator and cartridge storage is sanitary?
- yes
- no
- N/A
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If answer was "no" what is the correction date
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Respirators are stored in a cinched bag on shop floor?
- yes
- no
- N/A
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If answer was "no" what is the correction date
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Ear plugs used in designated areas?
- yes
- no
- N/A
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If answer was "no" what is the correction date
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IX. Eye Protection
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Eyewear meets Z87+, Z87-1+, Z87-2+ standard?
- yes
- no
- N/A
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If answer was "no" what is the correction date
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Safety glasses worn under weld helmet/face shield?
- yes
- no
- N/A
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If answer was "no" what is the correction date
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Double eye protection or goggles while grinding?
- yes
- no
- N/A
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If answer was "no" what is the correction date
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Double eye protection or goggles to blowdown? (3 ft Ext)
- yes
- no
- N/A
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If answer was "no" what is the correction date
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No readers with clip on side shields?
- yes
- no
- N/A
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If answer was "no" what is the correction date
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Goggles in use where required? Strap in place?
- yes
- no
- N/A
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If answer was "no" what is the correction date
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X. Fall Protection
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Ladders free from damage?
- yes
- no
- N/A
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If answer was "no" what is the correction date
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Ladders used and stored correctly?
- yes
- no
- N/A
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If answer was "no" what is the correction date
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Employees above 4' on steel or platforms are using personal fall arrest protection?
- yes
- no
- N/A
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If answer was "no" what is the correction date
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PFAS in use is anchored securely?
- yes
- no
- N/A
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If answer was "no" what is the correction date
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SRL in place for falls high work below 20 feet?
- yes
- no
- N/A
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If answer was "no" what is the correction date
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XI. Yard and Roadway Safety
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Shipping in all PPE with Reflective vests on roadways & job sites?
- yes
- no
- N/A
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If answer was "no" what is the correction date
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Employees working in Company Yards are wearing hard hats, safety glasses and steel toe boot/shoes? Including left truck drivers?
- yes
- no
- N/A
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If answer was "no" what is the correction date