Information

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • Is the gauge kept under constant control and visual surveillance on the job site?

  • Does the gauge operator know the emergency response procedures?

  • Was the dosimeter being properly worn during the operation of the gauge?

  • Is the gauge handle kept locked when not in use?

  • Is the shipping case locked whenever the gauge is not in use?

  • Is the gauge blocked and braced to prevent shifting during transport?

  • Did the gauge user have a copy of the transport papers at hand in the vehicle?

  • Is the shipping case secured in/to the vehicle? (2 locks)

  • Is the gauge stored correctly at the temporary job site? (2 locks)

  • Is ALARA being practiced?

  • Does the gauge user have any safety concerns?

  • Observations

  • Coaching

  • List any safety issues.

  • Authorized User

  • Auditor

  • Region

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