Title Page

  • Site Name

  • Customer

  • Date

  • Segment

  • Location (Region & Country)
  • Observer

  • Site Manager

  • Work Scope

  • Instructions

    1. Choose the best response for the questions below. Any "No" response must result in a "STOP WORK" until resolved.
    2. Add comments, observations, notes and images by clicking on the paperclip icon
    3. To add corrective actions, click on the paperclip icon then "Add Action", provide a description, assign to a member, set priority and due date
    4. Complete audit by providing digital signature
    5. Share your report by exporting as PDF, Word, Excel or Web Link

    NOTE: Refer to the guide below for more details

1.0 - Putting People to Work Safely

  • 1.1 Is a site-specific Projects & Services EHS Plan / Short Duration Safety Plan in place?

  • Provide supporting feedback:

  • Describe the non-compliance and corrective action(s):

  • Reason audit item was not applicable:

  • 1.2 Do all employees, contractors and visitors receive a site-specific EHS Induction?

  • 1.3 Is there evidence of performance of pre-task briefings and PoWRA?

  • 1.4 Are employees and Contractors aware of their authority to STOP WORK?

2.0 - Work Environment

  • 2.1 Are work areas free from slip / trip hazards and accumulated waste?

  • 2.3 Are floor and wall openings protected with rigid barriers / solid coverings?

  • 2.2 Are work areas are adequately illuminated?

3.0 - Tools and Equipment

  • 2.4 Are work areas adequately protected from adjacent hazards e.g. falling objects, sparks, arc flash, site vehicles?

  • 3.1 Is PPE identified in task-specific risk assessment available and worn?

  • 3.2 Are all hand and power tools maintained in a safe condition with no damage or defects and fitted with guards, as designed?

  • 3.3 Are power cables / hoses either routed so they do not cross vehicle or pedestrian routes, or suitably protected to prevent damage or a trip hazard?

  • 3.4 Are lifting and rigging equipment and accessories marked with the Safe Working Load (SWL) / Working Load Limit (WLL) and valid inspection status?

4.0 - FieldCore High-Risk Operations Focus* (2018)

  • 4.1 During observed lifting operations are personnel observed to be clear from suspended loads or between suspended loads and fixed objects at all times?

  • 4.2 When collective fall protection is not possible, are all persons working at height using a full body harness attached to a secure anchor point at all times?

  • 4.3 Is access to confined spaces forbidden unauthorized personnel and tests carried out before starting, during and after work to verify that the atmosphere safe for entry?

  • 4.4 Do Authorized Individuals either personally apply LOTO with a personal lock and verify absence of energy or implement alternative documented site-specific arrangements?

Additional Comments, Examples of Practice, Areas for Improvement

  • Provide applicable comments, best practices and areas of improvement.

Visit Completion

  • Completed by (Name and Signature)

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.