NOSA audit internal

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

1.11.2 Condition of buildings/structures

NOSA Element 1: Premises and Housekeeping

Element 1.11 Building and floors

1.11.1 Planned maintenance

• Maintenance schedule for buildings, floors and structures available and complied

  Yes

  No

  N/A

• Add media

  Media

1.11.2 Condition of building/structures

• Roof in sound condition

  Yes

  No

  N/A

• Add media

  Media

• Walls and support columns in sound condition

  Yes

  No

  N/A

• Add media

  Media

• Doorways and frames in sound condition

  Yes

  No

  N/A

• Add media

  Media

• Gutters and down pipes in sound condition

  Yes

  No

  N/A

• Add media

  Media

• Fixed ladders in sound condition

  Yes

  No

  N/A

• Add media

  Media

• Concrete and steel in sound condition

  Yes

  No

  N/A

• Add media

  Media

• Pipelines in sound condition

  Yes

  No

  N/A

• Add media

  Media

• Tanks in sound condition

  Yes

  No

  N/A

• Add media

  Media

1.11.3 Condition of floors

• Floors in sound condition

  Yes

  No

  N/A

• Add media

  Media

• Carpets in sound condition

  Yes

  No

  N/A

• Add media

  Media

• Roadways/Walkways in sound condition

  Yes

  No

  N/A

• Elevated platforms in sound condition

  Yes

  No

  N/A

• Tap to enter information

  Media

1.11.1 Planned maintenance

• Add media

  Media

NOSA Element 2: Mechanical, Electrical and Personal Safeguarding

• Office equipment in good condition

  Yes

  No

  N/A

• Add media

  Media

• Portable electrical equipment numbered, on register and inspected

  Yes

  No

  N/A

• Add media

  Media

• Machine guard/covers in place

  Yes

  No

  N/A

• Add media

  Media

• Adequate signage and in good condition

  Yes

  No

  N/A

• Add media

  Media

• Ladders numbered, in good condition and correctly stored

  Yes

  No

  N/A

• Add media

  Media

• Lifting gear inspected

  Yes

  No

  N/A

• Add media

  Media

• HCS safely stored, containers labelled and MSDS's available

  Yes

  No

  N/A

• Add media

  Media

• Forklifts in good condition, numbered as per register and daily checks conducted

  Yes

  No

  N/A

• Add media

  Media

• Hand tools in good condition, on register and inspected

  Yes

  No

  N/A

• Add media

  Media

• Safety belt/harnesses numbered, on register and inspected

  Yes

  No

  N/A

• Add media

  Media

• Compliance to PPE

  Yes

  No

  N/A

• Add media

  Media

• PPE registers available and signed

  Yes

  No

  N/A

• Add media

  Media

• Electrical panels locked

  Yes

  No

  N/A

• Add media

  Media

• dB Legends available and correct

  Yes

  No

  N/A

• Add media

  Media

• Lock-out system

  Yes

  No

  N/A

• Add media

  Media

• Boilers, pressure vessels and compressed gas cylinders<br>(certificates available, identified, inspection tests, safety valves, pressure gauges marked, portable gas cylinders correctly stored, flashback arresters on oxy-acetylene cylinders, pressure gauge and flow meters on medical oxygen, etc)

  Yes

  No

  N/A

• Add media

  Media

NOSA Element 3: Management of Fire and Other Emergency Risk

• Fire equipment available, inspected and on register

  Yes

  No

  N/A

• Add media

  Media

• Fire equipment signage in place and compliant (1.2m)

  Yes

  No

  N/A

• Add media

  Media

• Emergency plan displayed

  Yes

  No

  N/A

• Add media

  Media

NOSA Element 4: Incident Recording and Investigation

• Outstanding IOD/Incident/Unsafe Act or Condition Investigations

  Yes

  No

  N/A

• Add media

  Media

NOSA Element 5: Organisational Management

• Safety, Health and Environmental policies displayed

  Yes

  No

  N/A

• Add media

  Media

• First aid box in place, locked, first aider identified and first aid box inspected

  Yes

  No

  N/A

• Add media

  Media

• SHE meeting minutes available on SHE tracker and includes SHE rep inspections

  Yes

  No

  N/A

• Add media

  Media

Sign-off of Audit Report

• Date and Time of Audit

  Date

• Lead Auditor Signature

  Sign

• Acceptor Signature

  Sign

• Acceptor: Please rate the quality of the inspection conducted

  Very Good

  Good

  Average

  Bad