Employee Audit

• Employee Name

• Jobsite/Plant

• Address
  Address

• Vehicle/Equipment Number

• Conducted on

  Date

• Prepared by

PPE

• Hardhat - (Clean and compliant, worn according to manufacturer)

  Yes

  No

  N/A

• Safety glasses

  Yes

  No

  N/A

• Steel toe boots

  Yes

  No

  N/A

• Safety vest (clean and visible)

  Yes

  No

  N/A

• Ear Plugs / muffs

  Yes

  No

  N/A

• Gloves

  Yes

  No

  N/A

• Dust mask (N-95 only - clean and one time use)

  Yes

  No

  N/A

• Fall Protection

  Yes

  No

  N/A

Safety

• Are 3 points of contact being used?

  Yes

  No

  N/A

• Is employee operating equipment safely?

  Yes

  No

  N/A

• Are safe work procedures being followed?

  Yes

  No

  N/A

• Is employee using proper body positioning?

  Yes

  No

  N/A

• Are proper lifting/carrying techniques being used?

  Yes

  No

  N/A

• Is employee properly using LOTO where required?

  Yes

  No

  N/A

• Is employee using fall protection where required?

  Yes

  No

  N/A

Observations

• Comments/Observations

• Employee signature

  Sign

• Safety Representative signature

  Sign