Information
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Audit Title
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Document No.
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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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Select date
PPE
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Head Protection - Hard Hat
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Eye Protection
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Hand Protection - Proper Gloves
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Hearing Protection
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Foot Protection - Metatarsals if Required
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Respirator/Supplied Air Hood
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Arc Flash Gear - Gloves, FR Clothing, Face Shield
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Welding/Torch Cutting Eye Shade
Manual Lifting
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Correct Body Position
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Weight Under 50 lbs for Solo Lift
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Use Lifting Equipment for Weight Over 50 lbs
Line of Fire
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Hand/Body Position
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Overhead Hazards
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Rotating Equipment
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Eyes on Path
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Pinch/Sharp Edges Identified & Protected
Housekeeping
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Trash/Debris
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Cords/Hoses Orderly
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Barricades Used
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Protruding Items
Trip & Fall Protection
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Trip Hazards
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Fall Arrest Equipment Used
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Correct Ladder Use
Tool Use
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Correct Tool
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Used Correctly
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Guards Used
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Material Secured
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Damage to Cords or Tool
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GFCI Used in Wet Conditions
Equipment/Vehicle Use
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Seat Belt
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Safe Driving
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Fortlift Inspected (Driver's Shift)
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Overhead Crane Inspected (Daily)
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Backing - Looking/Sounding Horn
Nearby Work
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Aware of Vehicle Traffic
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Aware of Work Performed in Vicinity
Procedures
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Lockout/Tagout Procedures Followed
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Confined Space Permit Issued
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Confined Space Ventilator Used - 15 min Before & During Entry
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Confined Space Gas Detector Used - Before & During Entry
Ergonomic/Unnatural Body Position
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Awkward Bending/Leaning/Twisting/Squatting
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Stays in Same Position for Extended Time
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Holds Heavy Item/Tool for Longer Than 30 seconds
Notes
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Positive Feedback or Corrective Action
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Positive Feedback or Corrective Action
