Title Page

  • Site conducted

  • Conducted on

  • Prepared by

  • Is a contractor being audited?

  • Which contractor company?

Prework Aspects

  • Foundational aspects applicable to all Fatal Risks that address: housekeeping, workplace exams, FLRA, training confirmation, and emergency protocols.

  • Is the work area housekeeping in good order? (i.e., clear walkways and organized tools/materials)

  • Has a workplace exam been conducted?

  • Have all hazards been identified, corrected, or communicated?

  • Has the employee conducted a Field Level Risk Assessment (FLRA) or Team Risk Assessment (TRA)?

  • Has the employee received training? (i.e., task training, procedure or guidelines)

  • Can the employee explain the proper emergency shut down, summoning for help and evacuation procedures? 

Critical Control Verification

  • Critical Controls: Actions and conditions that must be in place and functioning 100% of the time, without fail, to protect people when working in potentially significant risk situations.

    Instructions: For each critical control, select Controlled, AtRisk, or NA (Not Applicable or not observed). See Assessment below for definitions. If something is marked AtRisk, immediately Pause the work until the missing protections are put in place. Write the corrective action taken in the notes box below

Competency

  • Has the worker been trained and authorized, and does the worker understand the components of working with hazardous materials

Identification of Chemicals

  • Do employees understand the hazards associated with the chemical(s) they will be handling or potentially exposed to? (e.g., health hazards, chemical reactivity, flammability)

  • Do employees know where to locate the Safety Data Sheets (SDS)?

  • Are employees wearing the correct type of PPE for the task being performed?

Handling and Storage

  • Do team members know and understand the procedure to follow when unknown substance is found?

  • Is the chemical compatible with the containers in which it is transferred/stored? (e.g., leaks or containment)

  • Are containers/pipes appropriately labeled and clearly legible? If applicable, what is the direction of flow?

  • Is the transfer/handling area easily accessible with proper containment measures in place?

  • Have the contents of the delivery truck been verified? Is the delivery driver following safe loading/unloading practices?

  • Are hazardous substances adequately stored and segregated based on SDS storage and segregation requirements?

  • Are pipes or other distribution systems used for hazardous substances clearly identified?

Controlled Access and Emergency Response

  • Are physical controls and signage (legible) in place to prevent unauthorized access?

  • Are hazardous substances stored in designated locations?

  • Do employees understand controlled access areas, exclusion zones, and evacuation procedures? (e.g., chemical leaks or explosives)

  • Do employees understand when and how to activate Emergency Call? (e.g., fire, spill, first aid, or chemical reaction)?

  • Does the team member understand immediate first aid measures (e.g., how long to eye wash/shower) when in contact with chemicals?

  • Are personnel knowledgeable of the monitoring and alarm systems required for the area where they are working? Do they know what to do when alarms are activated?

  • Do personnel know what to do when alarms are activated?

  • CONTROLLED The presence of this control is verified and effective

  • ATRISK This control is missing or ineffective

  • NA / NO Not Applicable to this exposure situation or Not Observed

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.