Title Page

  • Client / Site - where audit undertaken

  • Conducted on

  • Prepared by

  • Location / Address
  • Employee / Breaker Out


  • Is the Breaker Out wearing all required protective equipment?

  • Is the break out planned before return to strops?

  • Does the Breaker Out stand clear of moving ropes?

  • Have clear communication/signals been agreed with the extraction machine operator?

  • Is the strop position on logs OK (near end of logs)?

  • Are logs securely stropped (none falling off)?

  • Does the Breaker Out move to a safe retreat position before winch-in begins?

  • Were there any log breakages?

  • General comments about audit

Corrective Actions

  • Corrective Actions Required

  • Action Required
  • What corrective action is required?

Audit Sign Off

  • Sign Off

  • Employee
  • Signature

  • Job Title

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.