Title Page

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

PPE

  • PPE supplies are readily available (what PPE supply areas did you inspect?)

  • Is PPE being worn as requested?<br>(Who did you see wearing/not wearing the correct PPE? Do not use names)

  • Is PPE adequate for the job?<br>(What task did you observe?)

  • Other information

  • Photo

Plant/Tools & Equipment

  • Are tools in good working condition?<br>(List tools inspected)

  • All guarding is in place and not tampered with<br>(What machine/s did you inspect)

  • Existing guarding is sufficient<br>(What machine/s did you inspect?)

  • No hazards in the Plant/Equipment design?<br>(What machine/s did you inspect)

  • Plant/Equipment working well and not breaking down frequently? <br>(What machine/s did you inspect)

  • Other

  • Photo

Chemical Management

  • Chemicals are stored appropriately and segregated according to type and class?<br>(What storage areas were inspected)

  • Substances labelled appropriately?<br>(What substance did you look at?)

  • Safe Transportation means for chemicals is available?<br>(What are these methods)

  • Workers know where to find Safety Data Sheets (SDS)<br>(Find two and provide the substance names)<br>

  • Other observations?

  • Photo

Walking/Working Surfaces

  • Work platforms are non-slip and free of debris and clutter?<br>(Where did you inspect)

  • Railings/handrails in place where appropriate?<br>(List some examples you looked at)

  • Fall protection is in place for working at heights?<br>(What examples did you inspect)<br><br>

  • Labels in place for access and working environment are clear and legible?<br>(What signs did you look at)

  • Any working or floors surface is non slip even and clear of any items or debris<br>(Where did you inspect)

  • Other information

  • Photo

Emergency Response/Fire Protection

  • Fire Extinguishers are in place, inspected and tags marked 6 monthly<br>(Where were the extinguishers identified?)

  • Workers are aware of where emergency evacuation points are located?<br>(Who did you talk to? List at least 2 people)

  • Emergency Eyewash/Shower stations are in place and tested?<br>(What did you inspect?)

  • Spill kits are available, stocked as required and in good condition?<br>(Where are the spill kits you inspected?)

  • Emergency exits not blocked and identified by signage?<br>(What exists did you look at?)

  • Other observations

  • Photo

Mobile Equipment/Forklifts

  • Forklifts and other mobile plant are checked daily?<br>(List checklist samples or equipment inspected details)

  • Mobile equipment including forklifts are in good working condition?<br>(What items did you inspect?)

  • Traffic Management rules are appropriate and in place and no markings, bollards etc are worn out or damaged?<br>(What areas did you observe?)

  • Other observations

  • Photo

Electrical Hazards

  • Electrical equipment is tagged within current test date as listed on tag?<br>(What equipment did you inspect?)

  • Newly purchased equipment has been included in the preventative maintenance schedule (SAP)?

  • Areas where electrical items are used are clear from debris and suitable for task?<br>(What items did you look at?)

  • High Voltage signs in place and visible?<br>(Where are these signs located?)

  • Electrical leads are up off the floor and not obstructing walkways or work areas

  • Other observation

  • Photo

Lockout Tagout (isolation)

  • Workers who conducted LOTO are trained and appropriately equipped?<br>(Names of workers you spoke to)

  • LOTO procedures are in place and operating as intended <br>(Isolation that you inspected)

  • Electrical isolations are locked and tagged<br>(Isolation that you inspected)

  • Other observations

  • Photo

Crane/Hoist Safety

  • Inspections are completed as required?<br>(What crane/hoist did you inspect, when we're the inspection dates?)

  • Workers are not working under suspended loads?<br>(What areas did you inspect?)

  • Are Safe Working Loads (SWL) listed on all equipment?<br>(What lifting equipment did you inspect?)

  • Other observations

  • Photo

General Safety and Housekeeping

  • Warden and HSR signs are up to date and in place as required<br>(Name Warden and HSR that is listed)

  • Equipment is free of excessive dust, rust, oil or other contaminants?<br>(What equipment did you inspect?)

  • General tripping hazards are not present<br>(Where did you inspect)

  • Other observations

  • Photo

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