Title Page

  • Site conducted

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Previous Inspection

Previous Inspection Overview

  • Last Inspection was conducted by:

  • Score of previous Inspection

  • Date of Previous inspection

Action Items

  • Add all failed responses and corrective actions from the previous inspection:

  • Add Response
  • Personnel Notified:

  • Failed Response:

  • Was action corrected?

  • Corrective Action:

LSR 1. Risk Assessment

LSR 1. Risk Assessment

  • Risk Assessment Audit Questions:

  • Is a Risk Assessment being completed?<br>

  • Is there evidence of T-5s or other forms of safety meetings being conducted and documentation made available?<br>

  • Are emergency phone numbers posted near phones and kept up-to-date?<br>

  • Are SDSs up-to-date and readily available?<br>

  • Are first aid kits stocked with no expired products?<br>

  • Are first aid kits easily accessible?<br>

  • Is a trained first aider available on site?<br>

  • Are CRH Life Saving Rules posted?<br>

  • Are emergency lighting and exit signs routinely checked and properly maintained?<br>

  • Are all emergency exits in buildings properly identified?<br>

  • Are all emergency exits in buildings free of obstructions?<br>

  • Are radio communication with loaders and ground employees being utilized?

  • Do plant horns work for start up?

  • Are control house windows clear, with no obstructions to silos or load outs?

LSR 9. Use of Personal Protective Equipment (PPE)

FFE 9. Use of Personal Protective Equipment (PPE)

  • PPE Audit Questions:

  • Are hard hats being used?

  • Are high visibility safety vests or shirts being worn?

  • Are safety glasses or goggles being used?

  • Are safety toe boots being worn?

  • Is hearing protection available and used when required?

  • Are proper gloves available and worn when required?

  • Are loose clothing, adornments, and hair suitably controlled/confined to prevent entanglement with any machinery and device?

  • Are all PPE being worn in good condition?

  • Are dust masks made readily available?

  • Does the supervisor/foreperson have extra PPE?

  • Is the appropriate PPE made available for welding?

Liquid AC Loading/ Offloading required PPE

  • Liquid AC PPE Audit Questions:

  • Is a hard hat for AC loading/offloading have an adequate face shield with chin guard in good condition and readily available?

  • Is a flame-resistant jacket in good condition and readily available? (No lab coats because of pockets)

  • Is neoprene rubber gloves or adequate heat resistant gloves in good condition and readily available?

  • Is the H2S monitor available and functioning?

Arc Flash Required PPE

  • Arc Flash PPE Audit Questions:

  • Are the flash resistant clothing, coveralls or uniform in good condition and readily available?

  • Are the Arc Flash hard hats with face shield in good condition and readily available?

  • Are adequate gloves made available with Arc Flash equipment and in good condition?

  • Document date on gloves:

LSR 3. Isolation of Operating Machinery and Electrical Safety

LSR 3. Isolation of Operating Machinery and Electrical Safety

  • LOTO Audit Questions:

  • Is Lockout/ Tagout manual/policy up-to-date and being used properly?<br>

  • Are valves covers and lockout equipment devices available?<br>

  • Does each employee have their own lock?<br>

Mobile Equipment During Maintenance

  • LOTO for Mobile Equipment

  • Are steering wheel covers and other lockout equipment devices available and being used?

  • Are wheel chocks and jack stands available and used?

LSR 3. Isolation of Operating Machinery and Electrical Safety

Electrical Safety

  • Electrical Audit Questions:

  • Is all of the electrical wiring free of damage and fray?<br>

  • Are extension cords in good condition?<br>

  • Are electrical equipment operating between 50 and 600 volts protected against accidental contact by an approved cabinet or other enclosure?

  • Are GFCI provided on outlets around water and all extension cords?<br>

  • Is there a 3-foot clearance around electrical boxes?<br>

  • Are all electrical panels, breakers and disconnect boxes identified properly with Arc Flash labels?<br>

  • Are disconnects labeled to show what they control?

  • Are permanent splices in cable insulated, in good condition, and sealed from moisture?<br>

  • Are electrical cords across walk-ways protected/covered?<br>

  • Are there extension cords used in place of permanent wiring?<br>

  • Are all electrical switches, breakers, etc. properly labeled with what the operate?<br>

  • Is the Motor Control Center (MCC) entrances clearly identified as DANGER and restricted to authorized personnel?<br>

  • Is there sufficient access and working space provided and maintained around all electrical equipment including access to disconnect devices?<br>

  • Are there no extraneous combustible/flammable materials stored in MCC rooms?<br>

Fire Protection/ Prevention

Fire Protection/ Prevention

  • Fire Safety Audit Questions:

  • Are smoke detectors working properly?<br>

  • Are carbon monoxide detectors working properly, if applicable? Mechanic Shops, Offices Connected to Shops, Where Fuel Burners are used, etc.

  • Are fire extinguishers strategically located?<br>

  • Are all of the fire extinguishers visible and accessible?<br>

  • Do fuel dispensing areas have proper signage and adequate fire suppression readily available?<br>

  • Are monthly fire extinguisher inspections being logged? (Monthly punch tag is a best practice.)<br>

  • Are "no smoking" signs/ labels posted around flammable materials?<br>

  • Are flammable liquids stored in approved safety cans and containers?<br>

  • Are containers of flammable/ combustible materials stored in a flammable storage cabinet or other isolated areas and proper signage in place?<br>

  • Are flammable storage areas vented properly?

  • Are spill kits/ absorbent available?<br>

LSR 6. Working at Heights

LSR 6. Working at Heights

  • Working at Heights Audit Questions:

  • Is fall protection in good working condition?<br>

  • *Are employees/subcontractors working above 6 feet?<br>

  • Are employees/subcontractors equipped with adequate fall protection?

  • Are all ramps bermed half the distance of the largest equipment being used on ramps?<br>

  • Are chains or self-closing gates in use at top of all Fixed Vertical Ladders (FVLs)?<br>

  • Are all FVL more the 19 feet in length equipped with cage that extends at least 36 inches above the landing & starts not more than 7 feet from the bottom of the ladder, or are equipped with center-line fall protection?

  • If an employee is working from heights, is the area below barricaded-off half the distance they are working from?<br>

Ladder Safety

  • Ladder Safety Audit Questions:

  • Are ladders in good condition, without damages?<br>

  • Are ladders being inspected before each use?<br>

  • Are ladders being inspected monthly? (Monthly inspection stickers are in place and up-to-date.)<br>

  • Are labeling/marking on ladders legible?

  • Do all ladders have the capacity rating posted?<br>

  • Do all portable ladders have safety feet?<br>

Stairs and Walkways

Stairs and Walkways

  • Stairs and Walkways Audit Questions:

  • All stairs and walkways in good working conditions? (Kept clear and properly identified)<br>

  • Are proper height on all handrails, at least 42 inches?<br>

  • Are swing gates installed on all working platforms?

  • Are non-slip mats, gratings, false floors, and other like materials used in areas where slipping is a concern?

  • Are all mats, grates, etc. in good repair?

  • Are there toe boards on all walkways?

  • Do toe boards meet specifications and in good repair?

  • Are housekeeping practices carried out to ensure work areas are safe from trip/fall hazards to employees?

LSR 10. Safety of Materials Under Pressure

LSR 10. Safety of Materials Under Pressure

  • Safety of Materials Under Pressure Audit Questions:

  • Are all compressed gas cylinders secured in safe manner and properly capped when not in use?

  • Are oxygen cylinders stored from away flammable materials and at least 25 feet from flammable gas cylinders?

  • Are required inspections performed on all pressure vessels/ compressors?

  • Are storage areas for cylinder bottles labeled, "Full" or "Empty"?

  • Does all high pressure lines have the approved high pressure clamp? No radiator clamps?

  • Is compressed air used for cleaning purposes regulated to 30 pounds?

LSR 7. Lifting Operations

LSR 7. Lifting Operations

  • Lifting Operations Audit Questions:

  • Do all lifting implements such as straps, cables and chains have their load limit identified, as applicable?

  • Are lifting hoists inspected prior to each use with proper load limits posted?

  • Are employees only lifting objects less than 50 pounds on their own?

  • Are all hooks equipped with safety latches in good working condition?

LSR 4. Machinery Guarding

LSR 4. Machine Guarding

  • Machine Guarding Audit Questions:

  • Are all points-of-operations and pinch points guarded?

  • Is there barrier guards on moving machinery parts?

  • Are all floor holes, floor openings, hatchways, manholes, wall openings and skylights properly guarded?

  • Are all open sided floors, platforms and runways four feet or more above ground or floor level properly guarded and have toe boards installed?

  • Are belts/pulleys enclosed?

  • Are light bulbs guarded?

  • Are all belts and pulleys within 42 inches from the ground fully guarded?

  • Are all conveyor systems within 7 feet of walking/working surface equipped with a shut-off cable or guard?

  • Are auto start systems are identified by signage and have audible or visual alarms to warn employees in the area?

  • * Is there maintenance of silos occurring?

  • Are barricades used under silo drop gate?

Hot Work

Hot Work

  • Hot Work Audit Questions:

  • Are welding operations screened to prevent flash injuries?

  • Are extra fire extinguishers present for welding operations?

  • Is proper eye protection being worn for work being done?

LSR 2. Equipment Safety

Mobile Plant Safety

Pedestrian/Vehicle Segregation

  • Pedestrian/ Vehicle Segregation Audit Questions:

  • Are traffic flow signs posted, positioned appropriately and visible?

  • Are the appropriate signs in place around site? (Phone Use, Do Not Enter, Speed Limit, Pedestrian Crossing)

  • Is there a Pedestrian Segregation written plan in place?

Mobile Equipment

  • Mobile Equipment Audit Questions:

  • Are daily pre-use equipment inspections being done?

  • Is there a 3-Points of Contact decal in place on steps of all equipment?

  • Are wheel chocks made available and used when required?

  • Do employees understand and comply with the mobile phone policy?

  • Do all pieces of mobile equipment have slow moving vehicle signs, strobe light, and reflective tape?

  • Single Equipment Audit: (At a minimum, add one piece of equipment to the audit.)

  • Equipment
  • Equipment Number:

  • Is the equipment operator qualified?

  • Is the Operator Manual present?

  • Is good housekeeping practices being used in cab equipment?

  • Are seat and seat belts in good condition?

  • Are mirrors adjusted properly and in good condition?

  • Does the back-up alarm work properly?

  • Are access steps and railing in good working condition?<br>

  • Are parking brakes capable of holding mobile equipment with typical load on max grade?

Company Vehicles

  • Single Company Vehicle Audit: (At a minimum, add one company vehicle to this audit)

  • Company Vehicle
  • Company Vehicle Number:

  • Is the vehicle kept clean?

  • Are tires in good condition, and have good tread depth?

  • Are mirrors in good working condition?

  • Does the driver have current proof of insurance and vehicle registration?

  • Are seat belts in good condition?

LSR 5. Confined Space Entry

LSR 5. Confined Space Entry

  • Confined Space Audit Questions?

  • Is the Confined Space Manuel in place and being used properly?

  • Is the Confined Space Monitor being calibrated and logged before use?

  • Are bump tests being performed before each entry and logged?

  • Are all confined space areas properly labeled?

Housekeeping

Housekeeping

  • Housekeeping Audit Questions:

  • Is the site practicing good housekeeping in all buildings?

  • Are microwaves and refrigerators maintained in a sanitary and safe operational condition?

  • Is the site practicing good housekeeping of restrooms?

  • Is portable restrooms provided on-site if needed and maintained?

  • Is the site practicing good housekeeping throughout the site?

  • Are outside storage areas in good condition?

  • Are garbage containers provided and used?

  • Is the entrance to the yard and office clean and tidy?

  • Are all containers labeled and labeled correctly?

  • Are eyewash stations easily accessible and maintained?

Liquid AC Loading/ Offloading

  • Liquid AC Audit Questions:

  • Are hose and coupling in good working condition?

  • Are wheel chocks in good working condition?

  • Are unloading signs in place and legible?

Environmental Housekeeping

Housekeeping

  • Housekeeping Audit Questions:

  • Are all containers used to catch oil covered and or not exposed to the weather?

  • Is containment in good condition with no leaks and cracks?

  • Are there stains on the ground around the site that need to be cleaned up? (Check near fueling stations)

  • Are areas where water runoff leaves the site free of visible silt? (Please use site map to locate these areas)

  • Are dumpsters being kept closed?

  • Is wind blown trash being removed and placed in trash containers?

  • Are Used Oil tanks properly labeled as "Used Oil"? (Containers should not be marked as waste oil)

  • Is there evidence of offsite tracking of materials or sediment?

  • Are SDSs available for contents of all containers on-site?

  • Are all on-site containers, containing fluids, labeled as to their content?

  • *Does facility have proper structural controls? (berms, ponds)

  • Is structural controls effective and maintained?

  • Major concerns

  • concern
  • Description:

  • Photos to aid with description:

  • *Overall how do you rate the upkeep of the facility? (10 being excellent)

Documentation

Documentation On File

  • Documentation Audit Questions:

  • Where are Weekly Safety Talks including roster and materials kept?

  • Is there proof of all employees operating equipment being trained on-site or at local safety office?

  • Is there proof of all drivers being trained in the company safe driving programs (DDC or Smith System)?

  • Is there documentation of all required employees completing LOTO training on-site or at local safety office?

  • Is there documentation for all required employees who perform confined space entrance completing required training on-site or at local safety office?

  • Is there proof of all employees completing fall protection on-site or at local safety office?

  • Is there documentation that employees have received rigging and lifting training on-site or at local safety office?

  • Is there documentation that employees have received pressurized system training on-site or at local safety office?

  • Is there proof of employee engagement in Near Miss/Potential Hazard reporting, behavior observations, and/or mentoring program on-site or at local safety office?

Unsafe Conditions

  • Other unsafe behaviors and conditions observed on site:

  • unsafe observation
  • Description of observed:

  • Pictures to aid in observation:

  • Overall how do you rate the overall safety of the site 10 being fully compliant? (Please add comments to better aid site managers/staff)

Signatures

  • Check the box to approve that the above audit was done by a Safety Representative?

  • Safety Representative Signature:

  • Title:

  • Have the Site Manager or Site Representative check the box, agreeing that they received a briefing after the completion of the audit.

  • Site Manager/Site Representative Signature:

  • 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.