Internal NOSA Site Inspection

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

NOSA Element 1: Premises and Housekeeping

• Building and floors clean and in good condition

  Yes

  No

  N/A

• Add media

  Media

• Eating and drinking prohibitions adhered too

  Yes

  No

  N/A

• Add media

  Media

• Workplace tidy and clear of superfluous material

  Yes

  No

  N/A

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  Media

• Good stacking and storage practices

  Yes

  No

  N/A

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  Media

• Demarcation visible and complied with

  Yes

  No

  N/A

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  Media

• Lighting level sufficient - no lights out and windows clean

  Yes

  No

  N/A

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  Media

• Sufficient ventilation, fresh air, air movement

  Yes

  No

  N/A

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  Media

• Pollution of ground, air and water prevented

  Yes

  No

  N/A

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  Media

• Sufficient waste bins provided and frequently emptied

  Yes

  No

  N/A

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  Media

• Spill kits available and complete with content and signage

  Yes

  No

  N/A

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  Media

• Color coding in place

  Yes

  No

  N/A

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  Media

• Sanitation, plant hygiene and personal hygiene

  Yes

  No

  N/A

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  Media

NOSA Element 2: Mechanical, Electrical and Personal Safeguarding

• Office equipment in good condition

  Yes

  No

  N/A

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  Media

• Portable electrical equipment numbered, on register and inspected

  Yes

  No

  N/A

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  Media

• Machine guard/covers in place

  Yes

  No

  N/A

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  Media

• Adequate signage and in good condition

  Yes

  No

  N/A

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  Media

• Ladders numbered, in good condition and correctly stored

  Yes

  No

  N/A

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  Media

• Lifting gear inspected

  Yes

  No

  N/A

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  Media

• HCS safely stored, containers labelled and MSDS's available

  Yes

  No

  N/A

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  Media

• Forklifts in good condition, numbered as per register and daily checks conducted

  Yes

  No

  N/A

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  Media

• Hand tools in good condition, on register and inspected

  Yes

  No

  N/A

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  Media

• Safety belt/harnesses numbered, on register and inspected

  Yes

  No

  N/A

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  Media

• Compliance to PPE

  Yes

  No

  N/A

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  Media

• PPE registers available and signed

  Yes

  No

  N/A

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  Media

• Electrical panels locked

  Yes

  No

  N/A

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  Media

• dB Legends available and correct

  Yes

  No

  N/A

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  Media

• Lock-out system

  Yes

  No

  N/A

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  Media

• Boilers, pressure vessels and compressed gas cylinders<br>(certificates available, identified, inspection tests, safety valves, pressure gauges marked, portable gas cylinders correctly stored, flashback arresters on oxy-acetylene cylinders, pressure gauge and flow meters on medical oxygen, etc)

  Yes

  No

  N/A

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  Media

NOSA Element 3: Management of Fire and Other Emergency Risk

• Fire equipment available, inspected and on register

  Yes

  No

  N/A

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  Media

• Fire equipment signage in place and compliant (1.2m)

  Yes

  No

  N/A

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  Media

• Emergency plan displayed

  Yes

  No

  N/A

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  Media

NOSA Element 4: Incident Recording and Investigation

• Outstanding IOD/Incident/Unsafe Act or Condition Investigations

  Yes

  No

  N/A

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  Media

NOSA Element 5: Organisational Management

• Safety, Health and Environmental policies displayed

  Yes

  No

  N/A

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  Media

• First aid box in place, locked, first aider identified and first aid box inspected

  Yes

  No

  N/A

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  Media

• SHE meeting minutes available on SHE tracker and includes SHE rep inspections

  Yes

  No

  N/A

• Add media

  Media

Sign-off of Audit Report

• Date and Time of Audit

  Date

• Lead Auditor Signature

  Sign

• Acceptor Signature

  Sign

• Acceptor: Please rate the quality of the inspection conducted

  Very Good

  Good

  Average

  Bad