Information
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Audit Title
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Document No.
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
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Select date
1.0 PPE Correct
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1.1 Head Protection
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1.2 Eye/Face Protection
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1.3 Hand/Foot Protection
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1.4 Hearing Protection
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1.5 Clothing
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1.6 Respirator
2.0 Manual Lifting
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2.1 Correct body position
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2.2 Help for heavy items
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2.3 Hand placement
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2.4 Weight known
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2.5 Use of equipment
3.0 Line of Fire
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3.1 Hand/Body position
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3.2 Overhead hazards
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3.3. Rotating equipment
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3.4 Eyes on work or path
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3.5 Pinch/Shard edges identified & protected
4.0 Housekeeping
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4.1 Trash/Debris
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4.2 Cord/lead control
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4.3 Protruding items
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4.4 Correct barricades
5.0 Fall protection
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5.1 Trip hazard
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5.2 Fall arrest equip. use
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5.3 Correct ladder use
6.0 Tool Use
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6.1 Correct tool
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6.2 Used correctly
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6.3 Material secured
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6.4 Guards in place
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6.5 GFCI used
7.0 Equipment/Vehicle Use
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7.1 Seat belt use
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7.2 Inspection
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7.3 Equip. used properly
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7.4 Backing
8.0 Adjacent Work
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8.1 Equipment startup
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8.2 Vehicle traffic
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8.3 Work scope known
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8.4 Excavations
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8.5 Crane/Hoist use
9.0 Procedures
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9.1 Lockout/blinding
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9.2 Confined space
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9.3 Other procedure
10.0 Other
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Item # - What is positive or at risk? / Corrective action or commendation?
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Item # - What is positive or at risk? / Corrective action or commendation?
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Item # - What is positive or at risk? / Corrective action or commendation?
