Information
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Audit Title
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Document No.
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Site
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Conducted on
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Prepared by
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Location
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Personnel
Previous inspection
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Are there any outstanding items from the last visit report?
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If yes, please describe any open issues:
Work area inspected:
Observations
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Industrial Hygiene
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What types of IH hazards have been observed through your walk through?
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Respirable and/or Total Dust
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Noise
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Welding Fumes
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Other
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Please explain
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Using a Sound Level Meter on your cell phone, please take readings and pictures of the top two noise sources observed at the site. Record below.
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Source 1 dBA level
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Source 1 picture
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Source 1 description/location
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Source 2 dBA level
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Source 2 picture
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Source 2 description/location
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Respirable/Total dust locations (pick up to three)
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Source 1
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Description
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Source 2
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Description
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Source 3
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Description
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IH issues other than noise and dust. Please take picture and explain.
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Ask site manager the following:
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Has the site had an IH survey done in the past?
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Does the site have a noise map?
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Does the manager have any IH concerns? Please explain.
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IH risk level?
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Low
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Moderate
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High
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Please explain your decision.
Comments
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Signature of H&S Professional who Lead Walk Around
