Title Page

  • Audit Title

  • Prepared by

  • Position

  • Client / Site

  • Conducted on

  • Location
  • Personnel

PPE

  • Hard Hats

  • Safety Glasses and/or Face Shield and/or Goggles

  • Hearing Protection

  • Respiratory Protection

  • Gloves

  • Safety Toe Boots

  • Chaps

  • Sleeved shirt and long pants

  • High Visibility Shirt/Vest

  • Class 3 Vest

Mobile Equipment/Trucks

  • Equipment Inspected

  • Guarding of Machine Parts

  • Horns, Lights, Backup Alarms, Cameras all Working

  • Seatbelts Inspected and Worn

  • Floorboard Free of Clutter

  • Steps Clear of Debris

  • Fire Extinguishers Mounted and Inspected

Work Site

  • Organized Flow/Traffic Control

  • Standard Railing and Toe Boards Installed

  • Berms or Guards in Place

  • Electrical Hazards

  • Fire Extinguishers Mounted and Inspected

  • Eyewash Stations Inspected and Clear

  • Flammable Liquids and Gases Controlled

  • JSA’s Available

  • SDS’s Available

Personal Risk Management

  • Worker Responding To Hazards

  • Proper Lifting

  • Workers Trained for Task

  • Workers Protected from Falls Above 6ft.

  • Repetitive Motion Hazards

  • Extreme Cold/Heat - Hydration and Breaks

Trenching Site

  • 4’ - 5’ Deep - Egress Ladder within 25ft.

  • 5’ or Deeper - Properly Sloped/Shored/Shielded

  • Standing or Flowing Water Comtrolled

  • Spoil Pile Minimum 2’ Away from Edge

  • Soil Classified

  • Trenching Data Available/Trench Inspection Conducted

  • Utilities Marked

  • Workers Not Exposed To Cave-In or Falling Object

  • Competent Person Near By

Housekeeping

  • Egress Clear

  • Slips, Trips, Fall Hazards

  • Clutter

  • Vegetation Controlled

  • Food Consumed Properly

Employee Interview

  • Safety Statement

  • Toolbox Talk/JSA Conducted and Understood

  • Supervisory Support of Safety

  • Unchecked Hazards (Document Below)

Comments

  • Audit Positive Comments

  • Audit Corrective Comments

Driver/Operator Observations

  • Equipment #

  • Seatbelt Worn?

  • Free of Distractions (Cell Phone, Radio, etc.)?

  • Aware of Surrounding Hazards/Conditions?

  • Comments

Driver/Operator Observations

  • Equipment #

  • Seatbelt Worn?

  • Free of Distractions (Cell Phone, Radio, etc.)?

  • Aware of Surrounding Hazards/Conditions?

  • Comments

Driver/Operator Observations

  • Equipment #

  • Seatbelt Worn?

  • Free of Distractions (Cell Phone, Radio, etc.)?

  • Aware of Surrounding Hazards/Conditions?

  • Comments

Pictures

  • Pictures

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.