jvl 15 Element Audit E-4

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Control of hazardous energy

• Program is up to date?

  Yes

  No

  N/A

• Written procedures (msloto) up to date for all machinery (production,mechanical,etc?

  Yes

  No

  N/A

• Training for affected members is current

  Yes

  No

  N/A

• Training for affected members is as prescribed by the program?

  Yes

  No

  N/A

• There is a method to identify loot devices to members ( name or number)?

  Yes

  No

  N/A

• Determine the over all compliance of LOTO?

Confined Space

• Program is up to date?

  Yes

  No

  N/A

• Affected member training is up to date?

  Yes

  No

  N/A

• Training content matches the program requirements?

  Yes

  No

  N/A

• Authorized member training is up to date?

  Yes

  No

  N/A

• Training content matches the program requirements?

  Yes

  No

  N/A

• Determine the over all compliance for Confined Space

Personal Protective Equipment

• Affected member training is up to date?

  Yes

  No

  N/A

• Authorized member training is up to date?

  Yes

  No

  N/A

• PPE Hazard Assessment reflects all jobs at site?

  Yes

  No

  N/A

• Training content matches the program requirements?

  Yes

  No

  N/A

• Determine the over all compliance for Confined Space