Information
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
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Is the gauge kept under constant control and visual surveillance on the job site?
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Does the gauge operator know the emergency response procedures?
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Was the dosimeter being properly worn during the operation of the gauge?
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Is the gauge handle kept locked when not in use?
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Is the shipping case locked whenever the gauge is not in use?
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Is the gauge blocked and braced to prevent shifting during transport?
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Did the gauge user have a copy of the transport papers at hand in the vehicle?
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Is the shipping case secured in/to the vehicle? (2 locks)
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Is the gauge stored correctly at the temporary job site? (2 locks)
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Is ALARA being practiced?
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Does the gauge user have any safety concerns?
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Observations
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Coaching
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List any safety issues.
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Authorized User
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Auditor
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Region