Horizon Safety Group Safety Audit - Short Form

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

General Requirements and Postings

• Is the Fist Aid kit readily accessible?

  Yes

  No

  N/A

• Are Emergency Numbers available?

  Yes

  No

  N/A

• Is the EAP available?

  Yes

  No

  N/A

Fall Protection

• Are Employees using Fall Protection when required?

  Safe

  At Risk

  N/A

• Are employees using the Fall Protection system properly?

  Safe

  At Risk

  N/A

• Are the employees trained in the use of the Fall Protection system?

  Safe

  At Risk

  N/A

• Is the equipment inspected, stored properly and in good condition?

  Safe

  At Risk

  N/A

• Any additional conditions or hazards identified with Fall Protection?

  Yes

  No

  N/A

Electrical Safety

• Any additional conditions or hazards identified with Electrical Safety?

  Yes

  No

  N/A

Fire Protection

• Any additional conditions or hazards identified with Fire Protection?

  Yes

  No

  N/A

Housekeeping and Material Handling

• Any additional conditions or hazards with Housekeeping and Material Handling?

  Safe

  At Risk

  N/A

Tools

• Any additional conditions or hazards with Tools?

  Safe

  At Risk

  N/A

Ladders

• Any additional conditions or hazards with Ladders?

  Safe

  At Risk

  N/A

Scaffolding

• Any additional conditions or hazards with Scaffolding?

  Yes

  No

  N/A

Floor/Wall Openings, Stairways and Roofs

• Any additional conditions or hazards with Floor/Wall Openings, Stairways and Roof?

  Safe

  At Risk

  N/A

Aerial Lifts and Platforms

• Any additional concerns or hazards with Arial Lifts or Platforms?

  Safe

  At Risk

  N/A

Additional Conditions and/or Hazards Noted

• Notes

• Add signature

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