Information

  • Audit Title

  • Document No.

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • Select date

Personal Protective Equipment

  • Are all employees wearing F.R. (Fire Resistant) clothing?

  • Are all employees wearing hard hats?

  • Are all employees wearing steel toe boots?

  • If working in an environment where H2S gas may be present, are all employees wearing a gas clip and have it properly placed?

  • Are all employees wearing protective eye wear?

  • Are gloves, ear plugs, face shields, face masks, respirators, etc., being used when appropriate?

Procedures

  • Has a Job Safety Analysis (JSA) been completed and signed by all personnel?

  • Are the tasks/jobs that are being observed written in the JSA with hazards and mitigation and elimination strategies noted?

  • Are any permits (excavation, confined space, line finding, etc.) required? If so, have they been approved?

  • Are proper procedures for tasks being followed?

Work Environment

  • Is the work environment clean and orderly?

  • Are walking and working surfaces free of tripping hazards?

  • Is there a water log kept to monitor water intake for each employee?

  • Are there any overhead hazards that can potentially fall?

Position of People

  • Crush Points

  • Falls, Slips, and Trips

  • Contacting Extreme Temperatures

  • Contacting Electrical Current

Focus Behaviors

  • Are employees in the line of fire?

  • Is the proper technique used with suspended loads?

  • Are employees using proper harnesses and lanyards as well as 100% tie offs when utilizing aerial platforms?

  • Are forklift, aerial platform, backhoe, and other heavy machinery operators working safely in all work areas (using back-up alarms, spotters, taglines, appropriate straps and chokers, etc.)

  • Is any excavation being performed and has line finding been performed with proper documentation?

  • Are employees using proper lifting techniques?

  • Are hands and fingers in the proper position?

Tools and Equipment

  • Employees using the right tools for the job?

  • Employees using tools correctly?

  • Are tools in safe condition?

  • Are barricades, fencing, and other forms of warning used when appropriate?

  • Are hand and power tool guards and handles in place and are cords in safe operating conditions?

  • Are forklift, aerial platform, and backhoe operators certified?

  • Are there any electrical hazards or concerns?

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.