Information

  • Audit Title

  • Document No.

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Vehicle

  • Vehicle appearance inside and out

  • Vehicle lighting

  • Condition of Windshield/Glass/Mirrors

  • Tires

  • Cones/Placement

  • Horn/Wipers/Guages

  • Strobes and Flashers

  • Truck sticker in place and in good condition

  • Truck Mileage

  • Oil Change Current

  • Location and condition of fuel card

Personal Protective Equipment (PPE)

  • Mixing and Spray Gloves

  • Safety Glasses

  • Hard Hat

  • Long sleeve shirt

  • Hearing Protection

  • Respirator

  • Safety Vest

Documentation

  • Vehicle Paperwork

  • MSDS available and current

  • DOT CDL Paperwork

  • DOT Vehicle Paperwork

  • JSA

Other Safety Items

  • Fire Extinguisher inspected and working

  • Spill Kit

  • First Aid Kit available and fully stocked

  • Eye wash bottle

  • Drinking Water

Equipment

  • Backpack/Probe condition

  • Fuel Cans/Tanks

  • Hoses/Clamps

  • Chemicals labeled

  • Nurse Tank Condition

  • Skid Unit/Load Securement

  • Straps/Chains

Employee

  • Employee Appearance

  • Employee I.D.

  • Task Knowledge

  • Chemical mix knowledge

Aquatic

  • Boat condition

  • Life vests in good condition and in use

  • Rope

Heavy equipment/UTV

  • Harness and lanyard

  • Seatbelts (condition/signs of use)

  • Fire extinguisher

  • Greased fittings

  • Hoses/clamps

  • Tires

  • First aid kit

  • Air filter condition

  • Oil filter condition

  • Fuel filter condition

  • Guy wires flagged

Comments

  • Observation of good practices

  • Areas where improvement is needed

Items Dispersed

  • Equipment

  • Number of gift cards dispersed

Employee Signatures

  • Employee Signature

  • Employee Signature

  • Employee 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.