Title Page

  • Conducted on

  • Prepared by

  • Location
  • Team Member Conducting Audit:

  • Contractor Being Observed:

  • Location:

  • Area Being Observed:

  • Summery of job Task:

Section to Identify that all PPE, Equipment, and conditions are safe:

  • Are eye and or face protection being used?

  • Is appropriate respiratory protection used?

  • Is appropriate hand protection being used?

  • Is appropriate foot protection being used?

  • Is appropriate Hearing protection being used?

  • Are all Employees wearing FRC's?

  • Is fall protection being used?

  • Are H2S monitors or 4 gas monitors being used?

  • Are JSEA's/SOP's available for reference?

  • Are safety meeting/tailgate meetings being held?

  • Is training documentation available?

  • Are required permits available? (LOTO, Hotwork, Hazardous Work Permit, Etc.)

  • Is good housekeeping in place?

  • Have any spills been identified?

  • Are there any slip trip and falls?

  • Are machine guards in place?

  • Are cords/hoses in good condition?

  • are slings/chains/ropes in good condition?

  • Is there an emergency management plan in place?

  • Are lifting devices in good condition?

  • Have tools been inspected and are being used properly?

  • Are fire extinguishers available and inspected?

  • Are bonding cables and grounding equipment in place?

  • Are workers aware of Stop Work Authority?

  • Is a Hazard Communication system in place along with SDS for chemicals on location?

Positive Observations

  • Observation No. 1

  • Observation No. 2

  • Observation No. 3

  • Additional comments:

  • Additional Pictures

  • Contractor Signature

  • Observer Signature

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