Information
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Audit Title
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Document No.
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
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ACTIVITY DESCRIPTION:
HAZARDS
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1.1. Height
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1.2. Equipment
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1.3. Power Lines
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1.4. Electricity
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1.5. Sharp Objects
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1.6. Slippery / Wet Surfaces
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1.7. Gasses
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1.8. Dust
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1.9. Underground Utilities
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1.10. Overhead Obstructions
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1.11. Hazardous Substances
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1.12. Working In Isolation
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1.13. Ignition Sources
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1.14. Manual Handling
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1.15. High Pressure
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1.16. Lifting Equipment
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1.17. Rotating Machinery
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1.18. Entry & Exit
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1.19. Ground Openings
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1.20. Entanglement
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1.21. Animals, Pests
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1.22. High Voltage
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1.23. Confined Space
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1.24. Sun Rays / Adverse Weather Conditions
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1.25. Pollution
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1.27. Public Areas
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1.28. Other Hazards
CONTROL MEASURES
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2.1. Isolations
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2.2. Spotters
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2.3. Lighting
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2.4. Respiratory Protection
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2.5. Application of PPE
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2.6. Signage
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2.7. Barricades
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2.8. Fall Arrest
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2.8. Extinguishers
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2.9. Screens
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2.10. Fire Blankets
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2.11. Procedures
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2.12. Competent People
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2.13. Locating Equipment
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2.14. UV Protection
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2.15. Gas Detection
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2.16. Designated Work Areas
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2.17. Supervision of Public
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2.18. Other Control Measures
SIGN OFF
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Team Member
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Team Member
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Team Leader
