Title Page

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

ADMINISTRATION

  • Compliance poster posted

  • Emergency numbers paoted

  • Toll box talks documented

  • Industrial truck training current

  • D.O.T. Drivers files current

  • SDS sheets available

FACILITY/PUBLIC PROTECTION

  • Perimeter fencing secure

  • Perimeter signage posted

  • Visitor signage posted

  • Designated employee parking

  • Security lighting sufficient

  • Security system in place and operational

  • Speed limit posted

  • Emergency egress points identified and maintained

HOUSEKEEPING

  • Slip,trip,fall hazards

  • Trash and debris removed timely

  • Dunnage organized and stacked

  • Walkways and stair clear

  • Yard free of trash and debris

  • Drive line kept clear

  • Dumpsters accessible

  • Material and equipment travel paths sufficiently marked

  • Materials and equipment kept 3 feet from the perimeter fence

PERSONAL PROTECTIVE EQUIPMENT

  • Hard hats worn

  • Safety glasses worn

  • Face shields worn when needed

  • Chemical goggles worn when needed

  • Welding helmet or cutting goggles worn when needed

  • Gloves worn for the appropriate hazards

  • Hearing protection worn for the exposure

  • Hi-viz clothing worn for the exposure

RESPIRATORY PROTECTION

  • Appropriate respirator worn for the exposure

  • Medical evaluations conducted for the user

  • Respirator training documented

  • Respirators worn properly

  • Respirators stored properly

ELECTRICAL

CORDS

  • Cord in good condition

  • Cord protected from damage

Programs

  • Assured grounding program up to date

  • Lock out tag out program in place

Equipment installation

  • Electrical panels in good condition

  • Breakers properly identified

  • Panels protected from weather

  • Live parts guarded

  • Holes in panels properly covered

  • Cover plates installed

  • GFCI protection installed

Aerial/scissor lifts

  • Workers feet remain on the floor of the machine at all times

  • Fall protection utilized

  • Safety chain connected

  • Machine operated on flat level surface

  • Pot hole protectors operational

  • Changes in floor elevations protected

  • Machine operated per Mfg's recommendations

SCAFFOLDING

GENERAL SCAFFOLD REQUIREMENTS

  • Scaffold inspected and tagged for use

  • Base plates utilized

  • Cross bar aces installed

  • Guardrails installed

  • Toe boards installed

  • Scaffolding parts compatible

  • Proper access provided

PLANKS

  • 6-12 ovelap

  • Properly supported

  • Platform tightly planked

  • Planks free of knots ,split or cracks

HAND AND POWER TOOLS

  • Tools in good condition

  • Tools inspected before use

  • Tool guards installed and functionong

  • Cords inspected for damage

  • Strain relief functioning

  • Damaged tool tagged and removed from service

CRANES

GENERAL REQUIREMENTS

  • Cranes operated per Mfg's specs

  • Load chart available

  • Hand signals posted

  • Crane inspected daily

  • Current annual inspection available

  • Wire rope in good condition

  • Safety latches on hooks

  • Moving parts guarded

  • Cab Windows free of obstructions

  • Fire extinguisher in cab

  • Operated proper distance from power lines

CRAWLER/MOBILE CRANES

  • Crane setup on firm level surfaces

  • Boom in good condition

  • Outriggers set and tires off the ground

  • Outrigger pads properly connected and supported

  • Swing radius protected

  • Crane cab clean

FIRE PROTECTION

GENERAL REQUIREMENTS

  • Extinguisher properly located

  • Extinguisher charged and inspected

  • Flammable material stored in fire cabinets

  • Unobstructed access to fire hose bib

LPG

  • LPG bottles kept a minimum of 5 feet from the appliance

  • No direct heat on the bottle

  • Tanks not in use are stored outside

FUEL STORAGE

  • Proper containers used

  • Containers labeled with their contents

  • Fuel storage area bermed or a double wall tanks used

  • Machinery turned off during refueling

MATERIAL HANDLING AND STORAGE

STORAGE

  • Forklift path marked and clear of obstructions

  • Equipment and materials properly stored

  • Hardware containers stored to prevent water collection

  • Load limits posted on mezzanines

  • Maximum limits not exceeded on mezzanine stand racks

RIGGING

  • Rigging in good condition

  • Rigging load limits not exceeded

  • Tags on rigging equipment legible

  • Loads rigged properly

  • Rigging stored properly

WELDING AND CUTTING

GAS CYLINDERS

  • Properly stored 20 feet from combustables

  • Transported and stayed upright

HOSES

  • In good condition

  • Clear of pathways

TORCHES

  • Back flow preventers installed

  • Frictions lighters used

REGULATORS

  • Properly adjusted

  • Free from oil

WELDING LEADS

  • No repairs within 10 feet of stinger end

  • Leads in good condition

  • Connections and lugs insulated

WELDING OPERATIONS

  • Fire watch posted

  • Hot work permit completed

  • Slag contained

  • Combustibles moved or fire blankets utilized

  • Fumes ventilared

FALL PROTECTION

  • Fall protection provided and used

GUARDRAILS

  • Standard guardrails installed

  • Support 200lbs

  • Toe boards installed

PERSONAL FALL ARREST

  • Harness worn properly

  • Equipment in good condition

  • Compatible attachment made

  • No shop made devices used

  • Anchor point proper

  • Free fall issues

  • Lifelines protected from sharp/abrasive corners

VEHICLES AND EQUIPMENT

  • Equipment lights/beacons working properly

  • Cab glass free of obstructions

  • Horn functioning

  • Seat belts utilized

  • Unauthorized passengers

  • Loads secured properly

  • Fire extinguisher charged and inspected

  • Safety lighting operational

  • Job box secured

  • Pre-trip inspection conducted

  • CO checked when operating equipment indoors

STAIRWAYS AND LADDERS

USAGE

  • Ladders and/or stairs when needed (>19" elevation change)

  • Two points of egress provided

  • Handrails provided

STAIRWAYS

  • Handrails provided

  • Stairs free of obstructions

Ladders

  • Ladders secured

  • Ladders used properly

  • Ladders installed at a 4:1 pitch

  • Ladders inspected before first use

  • Area around top and bottom of ladder clear

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.