Field Assessment

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Permit to Work

• Has the Permit to Work been completed

  Yes

  No

  N/A

• Has the Permit to Work been signed by all parties?

  Yes

  No

  N/A

Job START

• Has the Job START been completed

  Yes

  No

  N/A

• Has the Job START been signed by all parties

  Yes

  No

  N/A

Job Analysis

• Has a Job Analysis been completed

  Yes

  No

  N/A

• Has the Job Analysis followed the Hazard Pathway Impact

  Yes

  No

  N/A

• Has it been signed by all members of the work party?

  Yes

  No

  N/A

Substances

• Are MSDSs available?

  Yes

  No

  N/A

• Are MSDSs up to date?

  Yes

  No

  N/A

• Have precautions been observed

  Yes

  No

  N/A

Is the work area safe?

• Have barricades been putinto place?

  Yes

  No

  N/A

• Is good housekeeping present

  Yes

  No

  N/A

Personal Protective Equipment

• Is PPE being used?

  Yes

  No

  N/A

• Is the PPE being used appropriate for the task

  Yes

  No

  N/A

• Is the PPE well maintained ie. clean, not broken

  Yes

  No

  N/A

Traffic Management

• Have the traffic control hazards been identified

  Yes

  No

  N/A

• Have the controls been put into place

  Yes

  No

  N/A

Excavation and Trenching

• Are the minimum regulatory requirements being met

  Yes

  No

  N/A

Confined Space Entry

• Are the correct procedures being observed

  Yes

  No

  N/A

Electricity

• Are the appropriate safeguards in place to protect against electrical hazards

  Yes

  No

  N/A

Working at Heights

• Are requirements being observed

  Yes

  No

  N/A

Training

• Have all personnel been trained for the task

  Yes

  No

  N/A

Isolations

• Are all isolations understood

  Yes

  No

  N/A

• Is all equipment tagged

  Yes

  No

  N/A

Zero Harm

• Do personnel understand the Zero Harm requirements?

  Yes

  No

  N/A

Environmental Management System

• Are site specific requirements being followed?

  Yes

  No

  N/A

• Are site requirements being observed?

  Yes

  No

  N/A

Quality

• Are task requirements being meet? Ie following procedures ect

  Yes

  No

  N/A

• Is test equipment within the calibration date

  Yes

  No

  N/A

• Is electrical equipment tested and tagged

  Yes

  No

  N/A

• Are the current document revision being used?

  Yes

  No

  N/A

Comments

Signature

• Auditor

  Sign

• Worker

  Sign