Information

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

HAZARDOUS ENERGY

  • Are LOCKS-TAGS being used for hazardous energy being use?

  • Corrective Action Required :-

  • Corrective action target date

  • Are LOTO available for all types of energy sources ? (electrical, steam, pressure)

  • Corrective Action Required:-

  • Corrective Action target date

  • Are LOTO plan and instructions visible ?

  • Corrective Action Required:-

  • Corrective action target date

  • Electrical panels kept closed and unblocked ?

  • Corrective Action Required

  • Corrective action target date

HOUSE KEEPING HAZARDS

  • Are floors dry, no standing water ?

  • Corrective Action Required

  • Corrective action target date

  • Are walking surfaces even ( no pothole, no slopes or edges )

  • Corrective Action Required

  • Corrective action target date

  • Floors are clear of any hoses, cords lying around ?

  • Corrective Action Required

  • Corrective action target date

  • The site have good 5S (clean, no clutter, no littering)?

  • Corrective Action Required :

  • Corrective action target date

HAND SAFETY

  • Are hand tools used in safe conditions ?

  • Corrective Action Required:

  • Corrective action target date

  • Are proper PPE being used to protect hand injuries ?

  • Corrective Action Required:-

  • corrective action target date

  • Are there Safe Plan of Actions in place ?

  • Corrective Action Required:-

  • Corrective action target date

  • Are hand tools being used properly without excessive force/ improper positioning ?

  • Corrective Action Required:-

  • Corrective action target date

FACILITIES/MAINTENANCE

  • Electrical wiring observed are safe - no exposed wires, dangling wires ?

  • Corrective Action Required:

  • Corrective Action Target Date

  • Machine guards in place and closed ? Interlock functional ?

  • Corrective Action Required :-

  • Corrective action target date

  • Water pipes, air compressors, steam pipes are working properly - no leaks ?

  • Corrective Action Required:-

  • Corrective action target date

  • Are materials stored and stacked properly - stable loads (e.g. pallets, cartons, boxes etc)

  • Corrective Action Required:-

  • Corrective action Target date

  • Are fire exits, fire extinguishers, fire alarms, fire hoses clear of any obstruction ?

  • Corrective Action Required:-

  • Corrective Action target date

  • Are fire protection equipment inspected regularly according to schedule ?

  • Corrective Action Required:-

  • Corrective Action Target date

WORKING AT HEIGHTS

  • Are PPE being used for working at heights ?

  • Corrective Action Required

  • Corrective Action Target Date

  • Is work permit available for working at height ?

  • Corrective Action Required:-

  • Corrective Action Target Date

  • Are there inspection tags available for ladders/platforms/scaffolding ?

  • Corrective Action Required :

  • Corrective action target date

  • Are there proper guard rails available for platforms/scaffolding ?

  • Corrective Action Required:-

  • Corrective Action target date

  • Are there Safe Work Procedure for Working at Height ?

  • Corrective Action Required:-

  • Corrective action target date

EMPLOYEE PRACTICES

  • Are you employees using proper PPE ?

  • Corrective Action Required:-

  • Corrective Action Target date

  • Lifting /material handling is properly done?

  • Corrective Action Required:-

  • Corrective Action Target Date

  • Pedestrian walkway is clearly marked and safe for use ?

  • Corrective Action Required

  • Corrective Action Target Date

  • Are Locks-Tags in use for all energy sources (e.g. Electricity, Steam, pressure) ?

  • Corrective Action Required

  • Corrective Action target date

  • Is LOTO plan and instruction visible ?

  • Corrective Action Required:-

  • Corrective Action Target Date

  • Electrical Panels closed and not blocked ?

  • Corrective Action Required

  • Corrective Action Target Date

CHEMICAL USE

  • Are chemical containers being stored properly ? ( proper segregation of hazardous chemicals, secondary containment available , good ventilation, spill kits available)

  • Corrective Action Required:-

  • Corrective Action Target Date

  • Is there proper chemical labeling on the containers? ( name, chemical characteristics, toxicity)

  • Corrective Action Required:-

  • Corrective action Target date

  • Chemical/Flavors managed properly ? No spillage ?

  • Corrective Action Required

  • Corrective action target date

  • Is there an Eyewash/Shower near the chemical use/storage area ?

  • Corrective Action Required:-

  • Corrective Action Target Date

  • Is flammable liquid being stored properly ( e.g. flammable cabinet)

  • Corrective Action Required :-

  • Corrective Action Target date

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.