Title Page

  • Site conducted

  • GM Location

  • Date

  • Company Name

  • Auditor's Name

  • Auditors Title

  • Factory/ Shop/ System

  • Name of Worker

  • Construction SCM Compliance?

  • Is the SCM Board to the common layout and was updated at the start of the shift?

  • Describe issues with the safety board

  • Are the PTP's for the day listed on the SCM Board along with SFMEA Score?

  • Describe Issues

  • PTP/ SW/ SOP/ WEP Compliance?

  • Can workers explain the Worker Safety Engagement Process and Purpose?

  • Describe Issues:

  • Does worker understand the Safe Work Zone (SWZ) technique?

  • Describe Issues

  • Did they have input prior to start of work?

  • Comments:

  • Can the worker explain Management of change?

  • Comments:

  • Are PTP's Being utilized for tasks being performed?

  • Comments:

  • Common Safety/Awareness (Is there Compliance?)

  • Does the employee know the emergency procedures?

  • Comments

  • If you could be hurt on this job how could it happen? How can you prevent it?

  • Mobile Device Policy

  • Are Workers following the Mobile Device Policy? (Not walking and talking, using mobile equipment while looking at mobile equipment)

  • Comments

  • PPE's

  • Are proper PPE's per GM's policy and their Pre-Task Plan being utilized?

  • Comments

  • Do all workers have appropriate footwear for the task the are performing? (Substantial footwear at minimum)

  • Comments

  • Working Alone/Isolations (Is there compliance with working alone or in isolated areas?)

  • Who is the workers communication Contact?

  • Comments

  • Who is the worker's communication contact?

  • Does the worker have a minimum frequency for check in? (Every 30 min)

  • Comments

  • Does the worker have a means to communicate in case of emergency?

  • Comments

  • Lockout Energy Control

  • Do locks and tags correctly identified with employee name, company, and contact number?

  • Comments

  • Can the employee explain the lockout process and proper testing after lockout?

  • Comments

  • Do workers know their company's process for removing locks on equipment or lockbox, after work has been completed?

  • Comments

  • Is SCS-MPS being used?

  • Can the worker show where the Safety instructions for the Tasks are listed on the SCS-MPS placard?

  • Comments

  • Does the person know what to do when performing a task that is not listed on the SCS-MPS placard?

  • Comments

  • Aerial Lifts

  • Does the ground person know how to lower the lift in case of emergency?

  • Comments

  • Has the Daily Inspection been completed for the lift?

  • Comments

  • Is the work area barricaded?

  • Comments

  • Powered Industrial Vehicles (Is there Compliance with Power Industrial Vehicles?)

  • Does the worker understand what an Orange Crush Zone is and the requirements are to enter?

  • Comments

  • Does The Worker Understand the two foot rule and explain "Wait for the Wave"?

  • Comments

  • Was the daily pre-op check completed?

  • Comments

  • Mobile Equipment being used for intended purpose?

  • Comments

  • Does operator have valid license?

  • Comments

  • Are Service Vehicles parked on slopes, are wheel securing devices present to prevent the vehicle from rolling?

  • Comments

  • Rigging and Lifting (Is there compliance with Rigging and Lifting?)

  • Do all lifting hooks have undamaged safety latches?

  • Comments

  • Is the lift area properly barricaded?

  • Comments

  • Scaffolding (Is all scaffolding compliant?)

  • Do all scaffolds have Green, Yellow or Red Tags and has been inspected daily by a competent person?

  • Comments

  • If Green Tagged are handrails, mid-rails and toe boards around all sides and no openings in the planking?

  • Comments

  • Is the Scaffolding anchored on mudsills or baseplates?

  • Comments

  • Use of Drones

  • Does the operator have a Remote Pilot Certificate from the Federal Aviation Administration or other regulatory agency with jurisdiction over use of a drone?

  • Comment

  • Can the operator explain how they are ensuring a continuous visual line of sight is maintained at all times during operation?

  • Comments

  • Welding / Hotwork

  • Does the dedicated Fire Watch understand their duties?

  • Comments

  • Are fire retardant blankets and fire extinguishers present in the work area along with fire watch?

  • Comments

  • Permits posted in the area?

  • Comments

  • Is the permit area identified and is the permit valid for today's date and time?

  • Comments

  • Is the area free from combustible materials?

  • Comments

  • Barricades

  • Are proper barricades in place and access gates to the area closed?

  • Comments

  • Is the access opening or gate closed?

  • Comments

  • Does the worker know the hazards present that require the area to be barricaded?

  • Comments

  • Is the proper signage posted (Caution/Danger, Name of Contractor, Contact name and phone number)?

  • Comments

  • Chemical Control

  • Does the worker know where eye wash stations/emergency showers are located?

  • Comments

  • Have workers received Hazard communication training and understand the hazards of the products they are using?

  • Comments

  • Does the worker know where to find the Safety Data Sheets for the chemicals?

  • Comments

  • Are all containers labeled with product name and appropriate hazard warnings such as GHS pictograms?

  • Comments

  • Are all containers stored in an upright and closed position?

  • Comments

  • Does the worker know what to do in the event of a spill or an exposure?

  • Comments

  • Confined Space

  • Does the Entry Permit or Pre-Task Plan have a rescue plan?

  • Comments

  • Is emergency rescue equipment located in close proximity to the Confined Space entry point?

  • Comments

  • Was security notified of the entry?

  • Comments

  • Does the space have appropriate signage?

  • Comments

  • Does the attendant know where the phone is located and the number to call?

  • Comments

  • Can the entrant and attendant explain the task and if the reviewed with a supervisor?

  • Comments

  • Does the entrant and the attendant understand their roles and the rescue plan?

  • Comments

  • Cranes

  • Do crane operator have their operators certificate on them

  • Comments

  • Has the operator completed the daily crane inspection log?

  • Comments

  • Are outriggers fully extended on outrigger pads or firm ground?

  • Comments

  • Electrical Safety

  • Are workers utilizing all necessary Arc Flash protection, insulated tools, and required PPE noted on the sticker?

  • Comments

  • Is the electrical equipment in good condition (no damage) and being used properly?

  • Comments

  • Are GFCI's present with all extension and corded power tools (magnetic drills excluded)?

  • Comments

  • Fall Hazard Control

  • Are all workers exposed to fall hazards 6' (2 meters) or higher for Construction or 4' (1.2 meters) or higher for General Industry using a full body harnesses, appropriate lanyards and anchorage points?

  • Comments

  • Can the employee explain the daily inspection of their equipment?

  • Comments

  • Is the employee working on an approved work surface and is is it posted with a load rating?

  • Comments

  • If the employee working on a ladder?

  • Is the ladder in good condition?

  • Comments

  • Is the ladder properly set up w/ the spreader arms locked?

  • Comments

  • If aerial lift is being used, is a competent ground person in position and do they know their responsibilities?

  • Comments

  • Are workers on extension ladder?

  • Are at least three rungs above the landing?

  • Is the extension ladder angled at a 4:1? (For every 4 feet in height the base is back 1 foot)

  • Housekeeping

  • Is the area clean, organized and are aisles, walkways, exits and stairs free of obstructions?

  • Comments

  • Are ladders and portable equipment stored properly?

  • Comments

  • Is material stored in a safe an organized manner?

  • Comments

  • Does the work area have liquids on the floor?

  • Comments

  • Are there trip hazards?

  • Comments

  • Finger Focus

  • Are guards present on all Rotating Spindle Tools?

  • Comments

  • Does the employee know what to do if a guard is missing?

  • Comments

  • Are Guards present on lifting devices to avoid pinched fingers?

  • Comments

  • Working Surfaces

  • Are walking working surfaces clear of debris, clutter, fluids and trip hazards?

  • Comments

  • Does the employee know who to contact to get fluids cleaned up?

  • Comments

  • Are Ladders in good working condition? (no damage, no build up on rungs, no missing rungs, bolts, etc.)

  • Comments

  • Additional Comments

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.