Formal FLRA audit

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Name of person being audited?

  Yes

  No

  N/A

• Area of work

  Yes

  No

  N/A

• Department

  Select Kitchen Utilities GSA Maintenance Recreation Commissary

  • Kitchen
  • Utilities
  • GSA
  • Maintenance
  • Recreation
  • Commissary

• Select date

  Date

• Comments

Audit

• Are the tasks listed?

  Yes

  No

  N/A

• Have all the hazards been identified?

  Yes

  No

  N/A

• Have all the controls been identified?

  Yes

  No

  N/A

• Are the controls identified on the FLRA on the card actively in place?

  Yes

  No

  N/A

• Is the FLRA card for the work being performed kept at the job location?

  Yes

  No

  N/A

• Does observed worker demonstrated a through understanding of the FLRA and their scope of work?

  Yes

  No

  N/A

• Is the emergency contact information on the FLRA ?

  Yes

  No

  N/A

• Has the worker dated the FLRA card?

  Yes

  No

  N/A

Audit rating

• Excellent - required FLRA standard achieved or surpassed

• Moderate - some coaching required for improvement

• Poor - inadequate FLRA with key requirements not met (work must stop)

• Auditor signature

  Sign