Information

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • Select date

  • Add media

  • Add drawing

  • Work Type:

Jobsite Hazard Analysis

  • Locking/Tagging Equipment

  • Working 6' or more above grade

  • Hot Work

  • Confined Space Work

  • Excavating & Trenching

  • Electrical Work >50 volts <600 volts

  • Electrical Work >600 volts

  • Operating Crane, stinger, manlift, forklift, etc.<br>

  • Mechanical Work involving rotating equipment

  • Other

Physical Hazards

  • Walkways

  • Cramped Work

  • Heat Stress

  • Heavy Liftingg

  • High Noise

  • Pressure

  • Hot Liquids

  • Hot Surfaces

  • Ladder Work

  • Lifting with Slings

  • Pinch Points

  • Road Hazards, Driving

  • Sharp Edges

  • Tripping/Objects

  • Overhead Lifting/Work

  • Electrical Work

  • Material Transfer; pipe; equipment; etc.

  • Ergonomics/Body Positioning

  • Chemicals/Gases/Asbestos/etc.

  • Other

  • PPE: hard hat, safety glasses, boots, etc.

Physical Hazard Controls

Emergency Action Planning

  • Evacuation Routes

  • Staging Area

  • Emergency Equipment Needed

  • First Aid/CPR Trained

  • Rescue Procedures Discussion

  • Emergency Contact Information

Hot Work

  • Combustion Engine

  • Grinding/Equipment Guards

  • Electrical Tools: Threader/Bender/etc.

  • Hand Tools

  • Gas Monitor

  • Fire Watch

  • Remove Combustibles

  • Worksite Classification

  • Fire Extinguisher

Confined Space

  • LO/TO

  • PPE

  • Emergency Rescue

  • Lines Blocked/Isolated

  • Area Secure

  • Respirators

  • Ventilation

  • Fire ext.

  • Signs in Place

  • Rescue Equipment

  • Non-Entry: Tripod, rescue winch, etc.

  • Entry: Harness, Wristlets, etc.

  • Job Safety Rating

  • Pass

  • Add signature

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.