Title Page

  • Client:

  • Prepared by:

  • Conducted on:

Safety Program Audit

Hazard Communication (Right to Know)

  • Written Plan

  • Annual Training Documentation

  • New Employee Training Documentation

  • Training Outline

  • SDS’s Available for Employee Review

  • Chemical Inventory List

  • Secondary Container Labeling

  • Notes


  • Written Plan

  • Annual Training Documentation

  • New Employee Orientation Documentation

  • New Employee Orientation Outline Available

  • Safety Committee Organized and Periodic Safety Committee Meeting Held

  • Employee Request for Corrective Action Forms Available

  • Management, Supervisor & Employee Responsibilities

  • In-house Inspection Forms Available & Documented Periodically

  • Disciplinary Policy Outlined & Enforced

  • Safety Goals Set & Reviewed

  • Notes

Injury Log OSHA 300

  • Recordable Injuries Logged are Current

  • Injury Reports Available & Reviewed by Safety Committee

  • 300A Log Posted (Feb. 1st – April 30th Annually)

  • Columns Totaled

  • Corrective Action Taken if Applicable

  • Notes

Lockout Tagout

  • Written Plan

  • Annual Training for Authorized Employees

  • Annual Awareness Training for Affected & Other Employees

  • Annual Program Audit Checklist

  • Equipment Specific Energy Isolation Checklists

  • Equipment Sufficient to Isolate all Operating Energy Sources

  • Authorized Employees Equipped with Their Own Lock & Tag

  • One Key per Lock

  • Equipment Sign-out Sheet (Non-mandatory)

  • Procedure for Device Removal by Supervisor or Another Authorized Employee

  • Compliance with Plan Enforced

  • Notes


  • Written Plan

  • Annual Training Documented

  • Job Hazard Analysis

  • Plan Enforced

  • Required Areas Posted

  • Employees Fit Tested

  • Supplied for Employees by Employer if Required

  • Notes

Respiratory Protection

  • Written Plan

  • Annual Training Documented

  • Medical Evaluations Documented & Updated

  • Annual Fit Testing Documented

  • Air Quality Monitoring Documented for Respirable Hazards

  • Filter Changing Frequency Documented

  • Policy for Non-mandatory Use of Respirators

  • Proper Storage

  • Notes

Blood Borne Pathogens

  • Exposure Control Plan

  • Annual Employee Awareness Training Documented

  • Annual Safety Committee/ERT Training Documented

  • Safety Committee/ERT Vaccination or Declination Forms Updated

  • Notes

Hearing Conservation

  • Written Plan

  • Annual Employee Training Documented

  • Affected Areas Posted

  • Noise Map Developed (Dosimeter Testing)

  • Variety of Hearing Protection Available for Employees

  • Proper Use Enforced

  • Annual Audiological Testing Conducted for Affected Employees

  • Notes

Confined Space Entry

  • Written Plan

  • Annual Training Documented

  • List of Authorized Employees

  • List of Permit Required Confined Spaces

  • List of Space Specific Hazards

  • Physical

  • Mechanical

  • Atmospheric

  • Safe Entry Procedures

  • Hazard Control Procedures

  • Air Monitoring Requirements

  • Oxygen

  • Flammables

  • Toxics

  • List of Confined Space Entry Equipment

  • Calibration Requirements of Air Quality Monitor

  • On-Site/Off-Site Rescue Team Acquired

  • If On-site, CPR/First Aid Certification of at least One Team Member

  • If Off-site, Documentation of Availability, Competence, & Knowledge of On-site Confined Spaces

  • Permits Retained for 3 Years

  • Confined Spaces Posted & Entry Restricted

  • Hot Work Permit Available – if Applicable

  • Responsibilities of Authorized Attendant & Entrant Defined

  • Policy for Cancellation of a Permit

  • Safe Entry Procedures into Non-permit Required Confined Spaces

  • Notes

Emergency Response/Contingency Plan

  • Written Plan

  • Emergency Response Team (ERT) Assigned Titles & Job Duties

  • Evacuation Maps Developed & Posted

  • Emergency Contact List Developed & Posted

  • Plan Sent to Appropriate Agencies (Cover Letters Available)

  • Chemical/Waste Inventory in Plan

  • Periodic ERT Trainings Held and ERT Meetings Documented & Minutes Recorded

  • Spill Kits On-site & Contents Listed in the Plan (Including an Explanation of how to use PPE)

  • ERT has Written Authority to Act

  • Incident Reports Available in Plan & Completed as Necessary

  • Notes

Fire Prevention Plan

  • Written Plan

  • List of all major fire hazards

  • Proper handling and storage procedures for hazardous materials

  • List of potential ignition sources and their control

  • List of the type of fire protection equipment necessary to control each major hazard

  • Procedures to control accumulations of flammable and combustible waste materials

  • Procedures for regular maintenance of safeguards installed on heat-producing equipment to prevent the accidental ignition of combustible materials

  • Name or job title of employees responsible for maintaining equipment to prevent or control sources of ignition or fires

  • Name or job title of employees responsible for the control of fuel source hazards

  • Notes

Emergency Action Plan

  • Written Plan

  • Procedures for reporting a fire or other emergency

  • Procedures for emergency evacuation, including type of evacuation and exit route assignments

  • Procedures to be followed by employees who remain to operate critical plant operations before they evacuate

  • Procedures to account for all employees after evacuation

  • Procedures to be followed by employees performing rescue or medical duties

  • List of every employee who may be contacted by employees in need of more information about the plan, or an explanation of their duties under the plan

  • Notes

Industrial Lift Trucks

  • Written Plan

  • Authorized Employee Training Documented

  • Classroom Training

  • Written Testing

  • Practical Driving Evaluation

  • License Available On Person

  • Per Shift Inspections Documented

  • Proper Use of Seatbelts

  • Periodic Retraining

  • Every 3 Years and After Unsafe Driving is Observed

  • Classroom Training

  • Written Testing

  • Practical Driving Evaluation

  • License Available On Person

  • Policy for Removing Forklift from Operation if Unsafe

  • ID Plates Legible

  • Recharge Stations Equipped with Appropriate PPE – if Applicable

  • Notes


  • undefined

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.