Field Audit For Safety And Quality

• Site

• Conducted on

  Date

• Today's Date

  Date

• Auditor's Name

• Work Order Number

• Technician's Name

• Work Order Date

  Date

• Work Order Priority

  One

  Two

  Three

  Four

• Work Order Status

  Open

  Closed

• Completed Date

  Date

• Brief Work Order Description

Safety-Two Minute Rule

• Employee(s) on the job identified and have reviewed/signed form?

  Yes

  No

  N/A

• Work Order number and job desription?

  Yes

  No

  N/A

• Job triggers identified (N/A if no triggers met)?

  Yes

  No

  N/A

• Work stopped if triggers met - Supervisor/Competent Person signature obtained (N/A if no triggers met)?

  Yes

  No

  N/A

• Hazards identified?

  Yes

  No

  N/A

• PPE identified?

  Yes

  No

  N/A

• Hazard mitigation for each hazard identified?

  Yes

  No

  N/A

• Other Comments

Safety - Other Safety Observed

• LOTO used and procedures followed?

  Yes

  No

  N/A

• Site policies and procedures followed (Confined Space, Hot Work, Barriers, etc.)?

  Yes

  No

  N/A

• MSDS procedures followed and the technician familiar with requirements?

  Yes

  No

  N/A

• Labor adequate to perform work safely?

  Yes

  No

  N/A

• Proper PPE available and being used properly (respirator, glasses, gloves, harness, hard hat, etc.)?

  Yes

  No

  N/A

• Other Comments

Quality Items

• Workmanship: Quality of workmanship of a high level?

  Yes

  No

  N/A

• Labor: Proper number of technicians appropriate for work effort?

  Yes

  No

  N/A

• Materials: Proper materials used?

  Yes

  No

  N/A

• Materials: Materials from site stores/crib and procured following procedures?

  Yes

  No

  N/A

• Proper work installation and repair methods used in work application?

  Yes

  No

  N/A

• PM/work procedures followed?

  Yes

  No

  N/A

• PM/work procedures initialed/documented?

  Yes

  No

  N/A

• Other Comments

Work Order Items

• Work order completed on time as set by priority?

  Yes

  No

  N/A

• Response time acceptable as set by priority?

  Yes

  No

  N/A

• Other Comments

Other Items

• Immediate work area clean and free of debris?

  Yes

  No

  N/A

• Work order accurate and complete?

  Yes

  No

  N/A

• Other Comments

• Auditor Signature

  Sign