General VSL Checklist

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• 1. Announce your intention to conduct VSL
  2. Audit in team and wear the required PPE
  3. Demonstrate CARE and Concern
  4. Discuss your findings with line management

LEADERSHIP

• Receptive towards a VSL audit?

  Room for Improvement

  Acceptable

  Excellent

  Not Applicable

• Site SHE Orientation?

  Room for Improvement

  Acceptable

  Excellent

  Not Applicable

• Is line management engaged?

  Room for Improvement

  Acceptable

  Excellent

  Not Applicable

GENERAL HOUSEKEEPING

• Process & Waste Storage Areas

  Room for Improvement

  Acceptable

  Excellent

  Not Applicable

• Office Areas

  Room for Improvement

  Acceptable

  Excellent

  Not Applicable

• Warehouse & Product Storage Areas

  Room for Improvement

  Acceptable

  Excellent

  Not Applicable

• Lab Areas

  Room for Improvement

  Acceptable

  Excellent

  Not Applicable

WORKER SAFETY

• Personal Protective Equipment (PPE)

  Room for Improvement

  Acceptable

  Excellent

  Not Applicable

• Pedestrian/Traffic Areas

  Room for Improvement

  Acceptable

  Excellent

  Not Applicable

• Emergency Equipments (Safety Shower, Eye Was Station, Fire Extinguisher, etc.)

  Room for Improvement

  Acceptable

  Excellent

  Not Applicable

• Equipments Safety

  Room for Improvement

  Acceptable

  Excellent

  Not Applicable

• Fork Truck Safety

  Room for Improvement

  Acceptable

  Excellent

  Not Applicable

COMMUNICATIONS

• SHE Communications

  Room for Improvement

  Acceptable

  Excellent

  Not Applicable

SAFE WORK PRACTICES

• Safety Work Permit Compliance

  Safe

  At Risk

  N/A

• Hot Work Permit Compliance

  Safe

  At Risk

  N/A

• Confined Space Permit Compliance

  Safe

  At Risk

  N/A

• Working at Height Compliance

  Safe

  At Risk

  N/A

BEST/GOOD PRACTICES

• Positive Observation

  Media

ACKNOWLEDGEMENT

• 1. Debrief your findings to the accompany area owner
  2. Agreed to improve the findings
  3. Thanks to the area owner

• Area Owner acknowledgement

  Sign

• Auditor's Signature

  Sign