Information
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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
A. GENERAL WORK AREAS
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01. FLOORS (clean, no tripping hazards)
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SEVERITY
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PROBABILITY
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02. AISLES / WALKWAYS (clear)
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SEVERITY
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PROBABILITY
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03. STAIRS (clear, rails secure)
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SEVERITY
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PROBABILITY
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04. LADDERS (rungs, feet, tied, hung)
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SEVERITY
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PROBABILITY
B. HAND TOOLS
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05. GENERAL CONDITIONS OF TOOLS
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SEVERITY
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PROBABILITY
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06. ELECTRICAL TOOL CORDS (undamaged)
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SEVERITY
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PROBABILITY
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07. GUARDS (in place and working)
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SEVERITY
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PROBABILITY
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08. AIR HOSES (proper clamps)
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SEVERITY
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PROBABILITY
C. ELECTRICAL
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09. CORDS (GFI, three pronged)
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SEVERITY
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PROBABILITY
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10. LIGHTING (clean, adequate)
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SEVERITY
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PROBABILITY
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11. PANELS (doors closed, clear)
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SEVERITY
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PROBABILITY
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12. EMERGENCY EXIT SIGNS (lit)
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SEVERITY
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PROBABILITY
D. CRANES / HOISTS / RIGGING
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13. SLINGS, ROPES, CHAINS (undamaged)
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SEVERITY
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PROBABILITY
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14. HOOKS (not spread, safety latches)
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SEVERITY
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PROBABILITY
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15. CRANE / HOIST (rating clearly marked)
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SEVERITY
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PROBABILITY
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16. SPREADER BARS (rating marked)
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SEVERITY
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PROBABILITY
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17. SUSPENDED LOAD (clear under load)
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SEVERITY
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PROBABILITY
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18. DAILY CRANE LOGS BEING COMPLETED
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SEVERITY
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PROBABILITY
E. MOBILE EQUIPMENT
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19. FORK TRUCK (logbook up to date)
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SEVERITY
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PROBABILITY
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20. AUTHORIZED OPERATORS (certified)
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SEVERITY
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PROBABILITY
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21. BACK UP ALARMS (operating)
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SEVERITY
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PROBABILITY
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22. HYDRAULIC SYSTEM (operational)
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SEVERITY
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PROBABILITY
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23. ELECTRICAL SYSTEMS (operational)
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SEVERITY
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PROBABILITY
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24. MECHANICAL SYSTEMS (operational)
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SEVERITY
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PROBABILITY
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25. PNEUMATIC SYSTEMS (operational)
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SEVERITY
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PROBABILITY
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26. FUEL SYSTEMS (no leaks)
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SEVERITY
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PROBABILITY
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27. TIRES (in good shape)
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SEVERITY
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PROBABILITY
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28. FIRE EXTINGUISHER INSTALLED
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SEVERITY
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PROBABILITY
F. MATERIAL STORAGE
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29. RACKS / SHELVES (secured down)
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SEVERITY
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PROBABILITY
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30. STACKED MATERIAL (stable)
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SEVERITY
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PROBABILITY
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31. FLAMMABLES (in fire proof cabinet)
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SEVERITY
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PROBABILITY
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32. COMPRESSED GASES (upright, tied)
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SEVERITY
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PROBABILITY
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33. FLAMMABLE MATERIAL (away from heat)
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SEVERITY
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PROBABILITY
G. CONTROLLED PRODUCTS
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34. LABELED CLEARLY
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SEVERITY
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PROBABILITY
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35. MSDS'S (available for all products)
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SEVERITY
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PROBABILITY
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36. WORKERS (WHMIS)
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SEVERITY
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PROBABILITY
H. PPE
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37. HARD HATS (wearing)
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SEVERITY
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PROBABILITY
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38. SAFETY GLASSES (wearing)
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SEVERITY
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PROBABILITY
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39. FACE SHIELDS / GOGGLES (wearing)
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SEVERITY
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PROBABILITY
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40. HEARING PROTECTION (wearing)
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SEVERITY
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PROBABILITY
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41. RESPIRATORY PROTECTION (wearing)
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SEVERITY
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PROBABILITY
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42. HAND / ARM PROTECTION (wearing)
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SEVERITY
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PROBABILITY
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43. STEEL TOED SHOES (wearing)
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SEVERITY
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PROBABILITY
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44. NO JEWELRY (rings, watches, necklaces etc.)
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SEVERITY
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PROBABILITY
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45. NO LOOSE CLOTHING
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SEVERITY
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PROBABILITY
I. HAZARD CONTROLS
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46. LOCK OUTS (in place)
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SEVERITY
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PROBABILITY
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47. CONFINED SPACES (procedures)
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SEVERITY
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PROBABILITY
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48. COLOR CODING (piping marked)
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SEVERITY
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PROBABILITY
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49. SCAFFOLDING (properly erected)
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SEVERITY
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PROBABILITY
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50. SIGNS & TAGS (in place)
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SEVERITY
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PROBABILITY
J. FACILITIES
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51. VENTILATION / HEAT (adequate)
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SEVERITY
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PROBABILITY
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52. EMERGENCY LIGHTS (operational)
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SEVERITY
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PROBABILITY
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53. FIRE HOSES (nozzles closed, hung)
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SEVERITY
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PROBABILITY
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54. FIRE EXTINGUISHERS (charged)
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SEVERITY
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PROBABILITY
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55. YARDS / ROADS (signs posted, gate)
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SEVERITY
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PROBABILITY
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56. PARKING LOT (clean, lit)
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SEVERITY
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PROBABILITY
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57. WASHROOMS (clean)
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SEVERITY
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PROBABILITY
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58. FIRST AID AREA (cleaned, stocked)
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SEVERITY
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PROBABILITY
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59. OFFICES (clean, tidy)
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SEVERITY
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PROBABILITY
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60. WASTE DISPOSAL (clean, removed)
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SEVERITY
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PROBABILITY
K. EMPLOYEE KNOWLEDGE
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61. 1st AID KITS (supplies, eyewash stations)
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SEVERITY
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PROBABILITY
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62. ACCIDENT REPORTING (procedures)
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SEVERITY
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PROBABILITY
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63. MEDICAL EVALUATION REPORTS
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SEVERITY
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PROBABILITY
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64. REPORTING UNSAFE ACTS (conditions)
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SEVERITY
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PROBABILITY
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65. EMERGENCY EVACUATION (procedure)
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SEVERITY
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PROBABILITY
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66. JOINT SAFETY COMMITTEE (rep)
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SEVERITY
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PROBABILITY
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67. Safe Work Procedures (understand the SWP for the work they are performing)
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SEVERITY
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PROBABILITY
L. MISCELLANEOUS
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68. CONVEYORS (emergency stops)
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SEVERITY
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PROBABILITY
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69. COMMUNICATION (radios working)
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SEVERITY
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PROBABILITY
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70. WORKING ALONE (procedure)
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SEVERITY
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PROBABILITY
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71. EMERGENCY NUMBERS (posted)
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SEVERITY
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PROBABILITY
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72. FIRST AIDERS (names posted)
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SEVERITY
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PROBABILITY
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73. WATER COOLERS (clean, tidy)
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SEVERITY
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PROBABILITY
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Add media
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SEVERITY
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PROBABILITY
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Add media
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SEVERITY
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PROBABILITY
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Add media
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SEVERITY
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PROBABILITY
CELEBRATING SUCCESS - MATRIX
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FORKLIFT INSPECTIONS
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CRANE INSPECTONS
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GARBAGES
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STACKED MATERIAL
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PPE & JEWELRY
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WATER COOLERS
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HOUSEKEEPING
INSPECTION SIGN - OFF
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SUPERVISOR
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MANAGEMENT REP
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WORKER COMMITTEE MEMBER REP
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ADDITIONAL MANAGEMENT REP
FOLLOW-UP REVIEW (Action Items)
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Plant Manager / General Manager. Date:
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Supervisor. Date:
