Generic EHS Audit Checklist for Medical Facilities

• Name of audited location

• Conducted on

  Date

• Prepared by

• Address of audited location
  Address

• Auditee and their designation

• Equipment inspected

• Audit observer(s) and their designation

• Work activity assessment for audit purposes

• Documentation

• Audit document number for reference

1) Emergency Evacuation & Preparedness

• 1.1-Aisles, passageways, and exit doors are free from obstruction?

  Yes

  No

  N/A

• 1.2-Corridors/passageways are at least 1.2 m wide?

  Yes

  No

  N/A

• 1.3-First aid kit in a well-lit and accessible location?

  Yes

  No

  N/A

• 1.3.1-Record expiry date of first aid kits [Add note for additional first aid kits]

  Date

• 1.3.2-List of first aiders clearly marked at a visible location?

  Yes

  No

  N/A

• 1.3.3-First aid kit inventory checked regularly?

  Yes

  No

  N/A

• 1.3.4-First aid kit is well stocked?

  Yes

  No

  N/A

• 1.4.1-Record expiry date of first aid kits (yyyymmdd) [Add note for additional first aid kits]

  Date

• 1.4.2-List of first aiders clearly marked at a visible location?

  Yes

  No

  N/A

• 1.4.3-First aid kit inventory checked regularly?

  Yes

  No

  N/A

• 1.4.4-First aid kit is well stocked?

  Yes

  No

  N/A

• 1.4-Customer safety signs such as emergency evacuation map/emergency exits/hazard communication/emergency contacts are present and clearly visible to staff?

  Yes

  No

  N/A

• Comments/Notes/Findings not captured in checklist for Emergency Evacuation & Preparedness

2) General Workplace Safety and Health

• 2.1-Customer staff (supervisor, health physicist, doctor etc.) is present during inspection?

  Yes

  N/A

• 2.2-The workplace is not overcrowded or cramped?

  Yes

  No

  N/A

• 2.3-Toilets/restrooms are clean, sufficient, well-ventilated with good lighting?

  Yes

  No

  N/A

• 2.4-The environmental conditions at the workplace is suitable and adequate with regards to temperature, light, humidity, noise, ventilation, dust, vibration, etc.

  Yes

  No

  N/A

• 2.5-Staff do not display prohibited practices (smoking, alcohol consumption, apply cosmetics, etc.)?

  Yes

  No

  N/A

• 2.6-The workplace displays good housekeeping practice to minimize slip, trip, fall, fire hazards?

  Yes

  No

  N/A

• 2.7-Are shelves/racks used at the workplace?

  Yes

  No

  N/A

• 2.7.1-Shelves/racks display the safe working load (SWL)?

  Yes

  No

  N/A

• 2.7.2-Shelves/racks are sturdy (not wobbly)?

  Yes

  No

  N/A

• 2.7.3-Shelves/racks have good structural integrity (no sunken platform/rusting/missing parts)?

  Yes

  No

  N/A

• 2.8-Gas cylinders are safely secured to a fixed object and restrained?

  Yes

  No

  N/A

• 2.8.1-Gas detectors are installed?

  Yes

  No

  N/A

• 2.8.2-Gas detectors are up-to-date on calibration/servicing/maintenance?

  Yes

  No

  N/A

• 2.8.3-Are the labels on the cylinders legible?

  Yes

  No

  N/A

• 2.8.4-Unused cylinders have valve protection cap securely in place?

  Yes

  No

  N/A

• 2.8.5-Safety datasheets for gas cylinders are accessible?

  Yes

  No

  N/A

• 2.8.6-Gas regulators show no signs of visible damage/deformity?

  Yes

  No

  N/A

• 2.9-Only compatible works are carried out?

  Yes

  No

  N/A

• 2.10-Staff (record name in notes) can briefly describe what is incompatible work?

  Yes

  No

  N/A

• 2.11-Are non-Work-At-Height PPE (eyewear, ear plugs, masks, helmets, footwear, clothing, gloves, etc.) available for staff to use?

  Yes

  No

  N/A

• 2.12-List of PPE available?

  Select

• 2.13-Are auditees wearing the correct PPE during the audit?

  Yes

  No

  N/A

• Comments/Notes/Findings not captured in checklist for General Workplace Safety and Health

3) Electrical Safety

• 3.1-Electrical safety signs are visible at appropriate locations?

  Yes

  No

  N/A

• 3.2-Cables are not damaged (frayed/worn/exposed wiring/cut/etc.)?

  Yes

  No

  N/A

• 3.3-Electrical connections (breakers/switches/plugs/etc.) are not damaged (burn marks/exposed wiring/holes/rust/etc.)?

  Yes

  No

  N/A

• 3.4-Electrical connections are not likely to come in contact with water or other liquids?

  Yes

  No

  N/A

• 3.5-Cables and connections show no sign of unsafe modifications?

  Yes

  No

  N/A

• 3.6-Extension cords are not daisy-chained?

  Yes

  No

  N/A

• 3.7-Plugs in use have safety logo?

  Yes

  No

  N/A

• Comments/Notes/Findings not captured in checklist for Electrical Safety

4) Fire Safety

• 4.1-Fire extinguishers are inspected, not expired, in visibly good working condition and unobstructed?

  Yes

  No

  N/A

• 4.2-Fire hose reels are inspected, not expired, in visibly good working condition and unobstructed?

  Yes

  No

  N/A

• 4.3-Fire detection system (smoke/heat/flame) is present?

  Yes

  No

  N/A

• 4.3.1-What is the fire detection system used?

• 4.3.2-Does the fire detection system show no visible signs of damage/corrosion?

  Yes

  No

  N/A

• 4.4-Fire suppression systems are present?

  Yes

  No

  N/A

• 4.4.1-What is the fire suppression system?

• 4.4.2-Does the fire suppression system show no visible signs of damage/corrosion?

  Yes

  No

  N/A

• 4.5-Electrical connections are not likely to come in contact with flammable materials?

  Yes

  No

  N/A

• 4.6-No stack/pile of combustible or flammable materials?

  Yes

  No

  N/A

• Comments/Notes/Findings not captured in checklist for Fire Safety

5) Chemical Safety

• 5.1-Chemicals are properly labeled according to GHS guidelines?

  Yes

  No

  N/A

• 5.2-Chemicals (including waste) are properly stored prior to disposal?

  Yes

  No

  N/A

• 5.3-Chemical spill kit present?

  Yes

  No

  N/A

• 5.4-Staff are able to briefly explain how to properly use the chemical spill kit?

  Yes

  No

  N/A

• Comments/Notes/Findings not captured in checklist for Chemical Safety

6) Work-at-Height (WAH) Safety

• 6.1-There are no open sides from which a person could fall from?

  Yes

  No

• 6.2-There are no openings on the floor from which a person could fall into?

  Yes

  No

  N/A

• 6.3-Guard rails are at least 1 m in height?

  Yes

  No

  N/A

• 6.3.1-If guard rails are not at least 1 m in height, what are the additional risk controls adopted?

• 6.4-Gaps in the guard rail are 60 cm or less?

  Yes

  No

  N/A

• 6.5-Is/are the field engineers(s) aware to inspect WAH PPE before each use?

  Yes

  No

  N/A

• 6.5.1-Could staff briefly describe how to inspect WAH PPE before use in a satisfactory manner?

  Yes

  No

  N/A

• 6.6-There are no fragile surfaces from which a person could fall from?

  Yes

  No

  N/A

• 6.6.1-Are the fragile surfaces marked and barricaded?

  Yes

  No

  N/A

• 6.7-Ladders show no visible damage/deformity?

  Yes

  No

  N/A

• 6.8-Take photos of ladders with attached safety standard label

  Media

• 6.9-Are staff aware of the need to inspect the ladder before use?

  Yes

  No

  N/A

• 6.10-Scaffolds and their components are regularly inspected by competent person?

  Yes

  No

  N/A

• 6.11-Scaffolds show no sign of visible damage/deformity?

  Yes

  No

  N/A

• 6.12-Are staff aware of the need to inspect the scaffold before use?

  Yes

  No

  N/A

• 6.13-Two horizontal and parallel guardrails on each side are in place and properly installed?

  Yes

  No

  N/A

• 6.14-The scaffolds platforms have toe-boards on all sides?

  Yes

  No

  N/A

• 6.15-Does the scaffold come with a user manual supplied by the manufacturer?

  Yes

  No

  N/A

• 6.16-Was the scaffold built to a recognized safety standard?

  Yes

  No

  N/A

• 6.17-Sample several WAH PPE. Do these show no visible signs of damage/deformity?

  Yes

  No

  N/A

• 6.18-Sample several WAH PPE. Are these current and not past expiry date?

  Yes

  No

  N/A

• 6.19-Are the WAH PPE properly stored and easily accessible?

  Yes

  No

  N/A

• Comments/Notes/Findings not captured in checklist for WAH Safety

7) Lifting Equipment Safety (e.g. crane/hoist/pulleys/rope/etc.)

• 7.1-Lifting tools/equipment show no signs of visible damage/deformity?

  Yes

  No

  N/A

• 7.2-Lifting tools/equipment are regularly inspected by a competent person?

  Yes

  No

  N/A

• 7.3-Are staff aware of the need to inspect the lifting equipment/tool before use?

  Yes

  No

  N/A

• Comments/Notes/Findings not captured in checklist for Lifting Equipment Safety

8) Lockout and Tagout (LOTO)

• 8.1-Lockout devices have no visible damage/deformity?

  Yes

  No

  N/A

• 8.2-Tags are legible, robust, and and understandable by all staff who may be in the area?

  Yes

  No

  N/A

• Comments/Notes/Findings not captured in checklist for LOTO Safety

9) Inspection on Other Equipment and Hand Tools

• 9.1-Sample several hand tools. Tools show no visible signs of damage/deformity?

  Yes

  No

  N/A

• 9.2-Where applicable, safety labels/signs are clear and affixed to the equipment?

  Yes

  No

  N/A

• 9.3-Patient treatment room/couch is clean and free from any potential biological hazards?

  Yes

  No

  N/A

• 9.4-Hand tools are stored safely in an organized manner?

  Yes

  No

  N/A

• Comments/Notes/Findings not captured in checklist for Equipment and Hand Tools Inspection

10) Waste Management (excludes chemical, radioactive waste)

• 10.1-Is there an agreement with the Customer for waste management (parts for scrapping, e-waste, etc.)?

  Yes

  No

  N/A

• 10.2-Is the waste properly segregated and stored prior to disposal?

  Yes

  No

  N/A

• Comments/Notes/Findings not captured in checklist for Waste Management

1) Emergency Evacuation & Preparedness

• 1.1-Varian staff received EHS instruction/training/communication from customer?

  Yes

  No

  N/A

• 1.2-First aider keeps a record of treatments?

  Yes

  No

  N/A

• Comments/Notes/Findings not captured above

2) General Workplace Safety and Health

• 2.1-Staff has access to updated EHS documents (procedures/risk assessments, etc.)?

  Yes

  No

  N/A

• 2.2-Staff has access to the latest work procedures ?

  Yes

  No

  N/A

• 2.3-How many courses in the training matrix have been completed?

• 2.4-Is there an appointed safety officer/lead to oversee daily EHS activities at the workplace?

  Yes

  No

  N/A

• 2.5-Do staff perform work using electric or gas welding machines?

  Yes

  No

  N/A

• 2.5.1-Please provide evidence of relevant training.

• 2.6-Do staff operate forklifts?

  Yes

  No

  N/A

• 2.6.1-Please provide evidence of relevant training.

• 2.7-Staff has undergone medical examinations as a requirement to perform work?

  Yes

  No

  N/A

• 2.7.1-Please provide evidence of medical examinations.

• 2.8-Site employees know to report incidents, near misses, and good observations to EHS and to the Site Manager?

  Yes

  No

  N/A

• 2.9-The site performs the monthly safety audit?

  Yes

  No

  N/A

• 2.9.1-Document evidence of completed monthly safety audits.

  Yes

  No

  N/A

• 2.9.2-Document evidence that a process is in place to correct discrepancies found in the monthly safety audit

  Yes

  No

  N/A

• Comments/Notes/Findings not captured above for General Workplace Safety and Health

3) Electrical Safety

• 3.1-Staff have completed Electrical Safety training on LMS?

  Yes

  No

  N/A

• 3.2-Provide evidence of other electrical safety training, if applicable.

  Yes

  No

  N/A

• Comments/Notes/Findings not captured above for Electrical Safety

4) Fire Safety

• 4.1-Provide evidence of fire safety training, if applicable

  Yes

  No

  N/A

• 4.2-Is there a list of appointed fire wardens?

  Yes

  No

  N/A

• 4.3-Provide evidence of fire warden training

  Yes

  No

  N/A

• Comments/Notes/Findings not captured above for Fire Safety

5) Chemical Safety

• 5.1-Safety data sheets (SDS), either in paper or softcopy, are accessible?

  Yes

  No

  N/A

• 5.2-Provide evidence of chemical safety training, if applicable

  Yes

  No

  N/A

• 5.3-Inventory of hazardous chemicals maintained and accessible on-site?

  Yes

  No

  N/A

• Comments/Notes/Findings not captured above for Chemical Safety

6) Work-at-Height (WAH) Safety

• 6.1-Staff performing WAH activities have the required license/training?

  Yes

  No

  N/A

• 6.2-Staff managing WAH activities have the required license/training?

  Yes

  No

  N/A

• 6.3-Is a list of WAH PPE assigned to staff available?

  Yes

  No

  N/A

• 6.4-WAH PPE are under a regular maintenance/inspection program?

  Yes

  No

  N/A

• 6.5-Are there safe means of entry and exit for WAH work activities?

  Yes

  No

  N/A

• 6.6-Varian staff using ladders at work completed EHS Ladder Safety training on LMS?

  Yes

  No

  N/A

• 6.7-Staff who move, operate, and inspect the scaffold are trained to recognize the hazards associated with it?

  Yes

  No

  N/A

• 6.8-Staff have completed the Fall Protection training on LMS?

  Yes

  No

  N/A

• Comments/Notes/Findings not captured above for Work-at-Height Safety

7) Lifting Equipment Safety (e.g. crane/hoist/pulleys/rope/etc.)

• 7.1-Is there a list of lifting tools/equipment used by staff?

  Yes

  No

  N/A

• 7.2-Staff have completed Overhead and Gantry Crane Safety Awareness training on LMS?

  Yes

  No

  N/A

• 7.3-Lifting equipment/tools have valid Lifting Machine (LM) certificate?

  Yes

  No

  N/A

• 7.4-Is there an established and implemented Lifting Plan?

  Yes

  No

  N/A

• 7.4.1-Is the Lifting Plan made available for inspection upon request by an inspector?

  Yes

  No

  N/A

• 7.5-Staff operating the overhead travelling crane has completed relevant training course?

  Yes

  No

  N/A

• 7.6-Staff supervising crane lifting operations has completed relevant training course?

  Yes

  No

  N/A

• 7.7-Staff performing rigging and/or signaling has completed relevant training course?

  Yes

  No

  N/A

• Comments/Notes/Findings not captured above for Lifting Equipment Safety

8) Lockout and Tagout (LOTO)

• 8.1-Staff have completed Lockout-Tagout training on LMS?

  Yes

  No

  N/A

• 8.2-Staff could briefly describe the LOTO procedures in a satisfactory manner?

  Yes

  No

  N/A

• Comments/Notes/Findings not captured above for Lockout and Tagout (LOTO)

9) Lone Worker

• 9.1-Has the Site Manager identified the areas and tasks at the site where the Lone Worker Rule applies?

  Yes

  No

  N/A

• 9.2-Were the site employees trained on the Lone Worker Rule before work began?

  Yes

  No

  N/A

1) Work-at-Height (WAH) Safety

• 1.1-Name of interviewee and designation

• 1.2-Date of interview

  Date

• 1.3-Start time of interview

  Date

• 1.4-Staff could briefly describe the procedures to follow when working at the top of the gantry with the crane as the anchor point?

  Yes

  No

  N/A

• 1.5-Staff could briefly describe the emergency procedures for WAH activities?

  Yes

  No

  N/A

• 1.6-End time of interview

  Date

• Comments/Notes/Findings not captured above for Work-at-Height (WAH) Safety

2) Electrical Safety

• 2.1-Name of interviewee and designation

• 2.2-Date of interview

  Date

• 2.3-Start time of interview

  Date

• 2.4-Staff could briefly describe the observer rule for work on exposed energized circuits of 50 V or greater?

  Yes

  No

  N/A

• Comments/Notes/Findings not captured above for Electrical Safety

3) Lockout and Tagout (LOTO)

• 3.1-Name of interviewee and designation

• 3.2-Date of interview

  Date

• 3.3-Start time of interview

  Date

• 3.4-Staff could briefly describe how to communicate during LOTO work when out of line of sight?

  Yes

  No

  N/A

• Comments/Notes/Findings not captured above for Lockout and Tagout (LOTO)

4) Work-at-Height (WAH) Safety Harness Demonstration

• 4.1-Name of interviewee and designation

• 4.2-Date of interview

  Date

• 4.3-Start time of interview

  Date

• 4.4-Staff could demonstrate putting on a safety harness correctly and adjusting to ensure good fit?

  Yes

  No

  N/A

• Comments/Notes/Findings not captures above for WAH Safety Harness Demonstration

• 1.1-Staff and designation

• 1.2-Date of assessment

  Date

• 1.3-Start time of assessment

  Date

1.4-Choose one of the following work activities for assessment.

• 1.4.1-Observe in real-time how the EHS monthly inspection is done by the site team using the provided checklist.

  Yes

  N/A

• 1.4.2-Mock demonstration of emergency rescue of fallen colleague hanging from a harness.

  Yes

  N/A

• 1.4.3-For specific work activity based on Varian maintenance and service documents, click Yes, and provide details in Question 1.5.

  Yes

  N/A

• 1.5-Description of work activity

• 1.5.1-Observed uncontrolled risks?

  Select General Safety and Health Electrical Fire Work-at-Height (WAH) Chemical Lockout-Tagout (LOTO) Radiation Lifting Equipment None observed

  • General Safety and Health
  • Electrical
  • Fire
  • Work-at-Height (WAH)
  • Chemical
  • Lockout-Tagout (LOTO)
  • Radiation
  • Lifting Equipment
  • None observed

• 1.5.2-What are the uncontrolled risks?

• Comments/Notes/Findings not captured above for Work Activity Assessment

• 1.1-Summary of audit findings

• 1.2-Summary of audit actions

• 1.3-Conclusion

• 1.1-Auditor name and signature

  Sign

• 1.2-Auditee name and signature

  Sign

• 1.3-Auditee name and signature

  Sign

• 1.4-Auditee name and signature

  Sign

• 1.5-Auditee name and signature

  Sign

• 1.6-Auditee name and signature

  Sign

• 1.7-Auditee name and signature

  Sign

• 1.8-Audit observers

  Sign

• 1.9-Audit end date

  Date

• 1.10 Audit end time

  Date