• Audit Conducted By

  • Conducted on

  • Facility

  • Unit

  • Personnel audited

1. Job Hazard Analysis

  • 1.1 Is there a JHA at the job location?

  • 1.2 Does the JHA include all required information and is it equate for the current task?

  • 1.3 Does the JHA adequately address the hazards of the task?

  • 1.4 Does the JHA adequately provide mitigation for the hazards?

2. Personal Protective Equipment

  • 2.1 Is proper eye protection being worn (eye shields, goggles for windy conditions or drilling activities)?

  • 2.2 Is proper hearing protection being worn (double protection in high noise areas)?

  • 2.3 Is hard hat worn?

  • 2.4 Is FRC required?

  • 2.4.1 Is FRC buttoned or zipped up completely?

  • 2.4.2 Is shirt tail tucked in?

  • 2.4.3 Are there any holes in garment?

  • 2.4.4 Is garment rated HRC 2?

  • 2.5 Are safety shoes worn and in good condition?

  • 2.6. Are proper gloves worn for the hazard?

3. Respiratory

  • 3.1 Is a respirator required?

  • 3.1.1 Does employee have a fit test card with them?

  • 3.1.2 Is employee wearing respirator that matches fit test (model and size)?

  • 3.2 Are cartridges and filters removed after use?

  • 3.3 Is respirator properly stored I plastic bag after use?

4. Administrative Controls

  • 4.1 Are the elements of the safe work permit being followed?

  • 4.2 Are the elements of the hot work permit being followed?

  • 4.3 Is employee working in a confined space?

  • 4.3.2 Does the attendant have communications with entrant?

  • 4.3.1 Did employee sign in and out on the CSE Entry Log?

  • 4.3.3 Does attendant understand the hazards of the entry?

5. Fall Protection

  • 5.1 Is employee required to use fall protection equipment?

  • 5.1.1 Is employee wearing the equipment correctly (strap adjustment and D ring location)?

  • 5.1.2 Is tie off to proper anchorage point and centrally above head where possible?

  • 5.1.3 Is there adequate clearance below employee should a fall occur?

  • 5.1.4 Is equipment inspected and color coded for current inspection cycle?

  • 5.2 Is fall protection equipment properly stored?

6. Housekeeping

  • 6.1 Is the work area clean (employee tools and equipment kept out of pathway or working area)?

  • 6.2 is employee working in area with slippery floors or where tripping hazards are present?

7. Elevated Work

  • 7.1 is employee working above or below other workers?

  • 7.1.1 is employee protected from falling materials from above?

  • 7.1.2 Has employee ensured that tools and materials are secure from falling to lower elevations?

  • 7.2 Is employee working on scaffold?

  • 7.2.1 Is scaffold tagged and safe for use?

  • 7.2.2 Is employee wearing fall protection and properly tied off if required?

8. Chemical Protection

  • 8.1 Is proper monitoring equipment worn (H2S, CO, CO2, LEL)?

  • 8.2 Has equipment been tested prior to use (bump test, H2S daily test)?

9. Vehicular Equipment

  • 9.1 Has a company provided vehicle been inspected within last 2 weeks?

  • 9.2 Is aerial device or scissor lift being used?

  • 9.2.1 Does operator have qualification card at site?

  • 9.2.2 Has equipment been inspected and documented prior to use?

  • 9.3 Has bicycle been inspected by safety in last 12 months?

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.