Title Page

  • Selected area for daily check

  • Auditor Name

  • Select date

  • Document No.

Housekeeping rules

  • Is duty board up to date

  • Take picture

  • Details

Handover

  • Have all handovers been conducted?

  • Detail Reasons

  • Number of Handovers completed

  • Any M.O.C

  • Any Safety Issues Identified for M.O.C
  • Any Safety Issues Identified for M.O.C

  • Choose area for M.O.C.

  • Detail the changes

Job Safety Analysis (JSA)

  • Are there any JSA's required for the tasks within the area?

  • Have all JSA's been conducted?

  • Detail Reasons

  • Number of JSA's conducted?

  • Any M.O.C

  • Any Safety Issues Identified for M.O.C
  • Any Safety Issues Identified for M.O.C

  • Choose area for M.O.C.

  • Detail the changes

Management of Change (M.O.C)

  • Can all below questions be answered yes for all operators?

  • Has a M.O.C been initiated?

  • Detail the reason why

  • 1. Have you done this task before
    2. Do you understand what you are required to do?
    3. Do you have the correct equipment required for the task?
    4. Have you Conducted pre inspection checks of equipment ?
    5. Do you have a process and requirements to follow?
    6. Are you following correct sequence?
    7. Are you aware of what to do if anything changes?
    8. Have you ever initiated a Management of Change?

Material movement and transportation

  • Select equipment being audited

  • fit to use

  • Signed Off, Correct Tag In Place For example
  • Add media

Additional information

    Additional information
  • Add media

Sign off

  • Supervisor Signature

  • Manager Signature (Verification only)

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.