• Audit Title

  • Document No.

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

1. General inspection

  • a. Is the JRR complete and compliant?

  • b. Are all required USafe posters up?

  • c. Are all required Federal, State labor posters up?

  • d. Has the HIPO document been completed and updated?

  • e. Has the site established and is running the USAFE program? E.g. Utake5, STARR, and HAZOB?

  • f. Has each employee signed the cardinal rules and the safety pledge?

  • g. Has the self inspection checklists been completed per each required program?

  • h. Are there JSA's per each HIPO task and has each employee reviewed and signed the JSA?

  • i. Has the site completed and or is up to date on all required safety training? And is it documented?

  • j. Has the site established shift start-up meetings and the weekly toolbox/tailgate meetings?

  • k. Has the site established a medical facility for work related injuries?

  • l. Is the OSHA 300 A posted and or filed along with the OSHA 300 log for record keeping?

2. General housekeeping

  • a. Are all storage / janitors closets neat and orderly?

  • b. Are all supplies properly stacked and not higher than the shortest employees?

  • c. Are all janitors carts neat and orderly?

3. Asbestos ACM

  • a. Is there ACM at the Site?

  • b. Has the site manager requested the asbestos survey from the customer? Did the manager receive it from the customer

  • c. Has all employees been trained in asbestos awareness and locations of the ACM and what it looks like?

  • d. Does to employee know who to report to if the ACM has been disturbed?

  • e. Does management know how to respond in case of an exposure?

4. Blood borne pathogens

  • a. Have personnel been designated for clean-up and is annotated on the HIPO document?

  • b. Has the authorized personnel been offered the HEP-B series vaccine? And has the waiver/ consent form for HBV been completed and filed?

  • c. Does the site have a current ECP and is it accessible to the employees?

  • d. Has those designated employees been trained on the proper clean-up procedures? And is it documented?

  • e. Does the site have BBP kits for access to the designated personnel and have back-ups in storage?

  • f. Has all employees received BBP awareness training in the past year?


  • a. Does the site have all required MSDs? And are they readily available?

  • b. Are all chemicals properly labeled?

  • c. Is the HAZCOM standard readily available to the employee's?

  • d. Is the master chemical inventory list completed? And up to date? "Not older than one year old"

6. Personal protective equipment

  • a. Is the proper PPE available to all employees?

  • b. Has the PPE Selection and risk assessment been completed for each task?

  • c. Are the employees wearing the proper PPE?

  • d. Are supervisors enforcing PPE requirements?

7. Emergency Evacuation

  • a. Has the site conducted Em evac training within the fiscal year and is it documented?

  • b. Does the site have a site program or have they adopted the customers EAP?

  • c. Does the site conduct action drills? Or do they participate in the customers drills? Is it documented?

  • d.

8. Electrical safety

  • a. Are electric cords in good working order? Not missing grounding prongs, no cuts or exposed wiring..

  • b. Are GFCI's being used for wet work?

  • c. Has LOTO program been established and in place?

  • d. Are all electrical equipment in good working order? Double insulated, grounding prong, no breaks or cut in the insulation.

  • e. If equipment is out of order is it tagged as such?

  • f. If LOTO is being conducted does each piece of equipment have an ECP/ LOTO Procedure?

  • g. Are the LOTO devices; durable, standardized, substantial, identiable?

  • h. Is a periodic inspection performed of the ECP procedures?

  • i. Are employee's trained in LOTO procedures? Authorized? Affected?

  • j. Is the employee/s trained to the NFPA 70E industrial standard?

  • k. Are required employee's completed arc flash / short circuit analysis?

  • l. Does the employee have the proper PPE and tools as categorized by the NFPA 70E requirements?

  • m. Has the electrical tools been annually voltage tested and certified?

9. Power tools / hand tools

  • a. Proper tool being used for each job?

  • b. Inspections and documentation of and damaged tools tagged and removed?

  • c. Proper training provided on tool use and documented?

  • d. Properly grounded (GFCI's), cords and plugs in good condition?

  • e. Proper PPE is used

  • f. Compressed air shall not be used for cleaning purposes except when reduced >10 p.s.i. & chip guard used.

  • g. Tools are properly stored when not in use

  • h.

10. Ladder safety

  • a. Step ladders used in the fully open position / do not use top two rungs of stepladder /. No metal or wooden or job built ladders..

  • b. Are employees trained in the proper use of ladders?

  • c. Are ladders inspected prior to use, monthly, quarterly! Color coded, ladder daily tag?

  • d. All tools and materials are to be raised and lowered by rope or machine?

  • e.

11. Drivers safety

  • a. Are the site drivers authorized and annotated in the HIPO document?

  • b. Are they qualified to operate company vehicles? Drivers licenses and DMV background checks?

  • c. Has the authorized company driver been trained in defensive driving?

  • d. Is there a fire extinguisher in the vehicle? Have they been trained to use it? Is inspection up to date?

  • e. Is there a first aid kit in the vehicle?

  • f. Is there regular inspection being performed daily, weekly, monthly?

  • g. Is there assigned drivers for the vehicles? Are they responsible for inspections and maintenance of the vehicle?

12. Electric carts

  • a. Are only authorized drivers allowed to drive an electric cart?

  • b. Are the drivers properly trained and documented?

  • c. Does the authorized drivers have a valid DL?

  • d. Are regular inspections and maintenance being conducted and documented?

13. Flammable liquids & gases

  • a. All containers are clearly marked / appropriate signage posted

  • b. Are chemicals properly labeled?

  • c. Are all chemicals stored and segregated by classes per manufacturer / federal requirements?

  • d. Is propane stored properly? Not in the building...

  • e. Are all flammable liquids and aerosols stored in a flammable cabinet?

  • f. Is there an inventory on the cabinet or near with MSDS's readily available?

  • g. Proper storage practices observed (20 lb ABC extinguisher within 25' - 75')?

14. Fall protection

  • a. Written Fall Protection Plan (if deviations from 100% fall protection)

  • b. Competent person training

  • c. Are those authorized employees properly training in fall protection? And is it documented?

  • d. Safety harnesses, lanyards and lifelines inspected properly, before use, monthly, quarterly? Is it documented?

  • e. Those employees who are authorized to use aerial lifts; are they properly trained and is it documented?

  • f. When using aerial lifts; Does the operators barricade off the area so no one can get hit by falling objects?

  • g. Are employees protected from falling objects

  • h. When working on roof tops are authorized employees the inside the 10' barrier? Are they wearing their PFE and are they anchored to an certified anchor point?

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.