Title Page

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Housekeeping:

  • Accumulation on/in Equipment Poor-0 Fair-4 Good-8 Excellent-10

  • Picture

  • Accumulation on walls, ceilings & floors Poor-0 Fair-4 Good-8 Excellent-10

  • Picture

  • Clutter inside office area and Outside plant area Poor-0 Fair-4 Good-8 Excellent-10

  • Picture

  • Temperature systems in working order, read regularly, problems reported. Poor-0 Fair-4 Good-8 Excellent-10

  • Picture

  • Grain Spillage (outside/plant-wide) (ON GOING OBSERVATION) Poor-0 Fair-2 Good-6 Excellent-9

  • Picture

Safety & Sanitation:

  • PPE Policy & Procedures followed (ON GOING OBSERVATION) Overhead storage, Exits maintained, Hardhats, Harness Inspections Poor-0 Fair-4 Good-8 Excellent-10

  • Ladder/Guarding/Platforms/Walkways (ON GOING OBSERVATION) Poor-0 Fair-2 Good-6 Excellent-9

  • Picture

Electrical:

  • Interior of boxes, starters clean/sealed 3' area around boxes, outlets/switches, Lights Poor-0 Fair-4 Good-7 Excellent-9

  • Picture

  • Boxes, starters, conduit etc. in good repair, extension cords, welders, LB covers Poor-0 Fair-4 Good-8 Excellent-10

  • Picture

  • Boxes, Starters Identified for their use & high voltage signs posted. Boxes kept closed. Poor-0 Fair-2 Good-6 Excellent-8

  • Picture

Maintenance Program:

  • Preventative Maintenance Log for: Conveyance Equipment, Bulk Liquid Fertilizer Storage (if applicable) Poor-0 Fair-3 Good-6 Excellent-10

  • Manlifts Poor-0 Fair-2 Good-7 Excellent-9

  • Picture

  • Fire Extinguishers - Checked Monthly Keep 3' area around clear Poor-0 Fair-1 Good-3 Excellent-6

  • Daily record keeping: Fork Lift, Skid Loader, Wrangler, 4 Wheeler, Kubota, Other Equipment. Poor-0 Fair-1 Good-4 Excellent--6

Safety:

  • Meetings Monthly (minimum) Poor-0 Fair-2 Good-4 Excellent-6

  • Safety Info Center (table/shelf) & Written Programs Poor-0 Fair-1 Good-2 Excellent-3

General:

  • Product Labeling/Containment/Security Poor-0 Fair-1 Good-3 Excellent-6

  • Picture

  • Vegetation Control (weeds/grass) Poor-0 Fair-2 Good-2 Excellent-4

  • Picture

  • Truck Scales Poor-0 Fair-3 Good-6 Excellent-9

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.