Title Page
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
1.0 General
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1.1 Housekeeping maintained?
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1.2 Flagging, barricades and signage in place?
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1.3 Ground conditions?
2.0 Documentation
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2.1 Stepback complete?
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2.2 JSA reviewed?
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2.3 Permit complete and available for review?
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2.4 Notification, detours or special instructions communicated to those affected by work.
3.0 Tools, equipment and chemicals
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3.1 Vehicle inspection complete?
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3.2 Tools/ladders inspection complete?
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3.3 PPE inspected and in use?
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3.4 Drip tray available and spill kit?
4.0 General comments/observations
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General comments, observations or positive feedback
Corrective actions (Work order number)
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Manager, Supervisor, HSE
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Employee
