• Document No.

  • Audit Title

  • Plant Location

  • Add location
  • Conducted on

  • Prepared by

  • Signature

Confined Space Program

  • Spaces labeled?

  • Evaluate CS rescue equipment as listed on the log - App B

  • Evaluate CS entry and rescue ropes

  • Evaluate CS Atmospheric Monitoring Devices as listed on the log - App C

  • Other

Contractor Safety Program

  • Review new system

  • Review any files of exempted contractors

  • Review self inspection audits

  • Review plant inspections

  • Review orientation records

  • Other

Emergency Response and Action Plan

  • External and Internal locations posted

  • Evacuation maps posted in facility (including revision dates)

  • Evaluate emergency exit signs/lights

  • Egress - exit access, the exit, and the exit route<br>Aisle way and exit routes are not blocked and clearly labeled

  • Exit doors - hinged, open in the direction of travel, not blocked

  • Evaluate Emergency Response Equipment (suits, boots, SCBAs, etc.)

  • Other

Electrical Safety Related Work Practices

  • Exposed wiring

  • Improper use of SO cords (wrapped cords, doorways, walls, etc...)

  • 110 panel labeling current and correct (including revision date)

  • Equipment (buckets, cans, disconnects) labeled

  • Fire extinguisher and emergency lighting in panel rooms

  • 3 foot clearance in front of electrical panels

  • GFCI used in wet areas

  • Clean anti-static mats being utilized at panels

  • Missing covers or knock outs

  • Broken or unsecured conduit

  • Sub stations over 600 volts locked

  • No storage of non essential electrical equipment in MCC panel rooms

  • MCC panel rooms locked

  • Infra red scan current and corrective action of identified hot spots - No critical or serious

  • Other

Ergonomic Program

  • Ergonomic improvements on floor

  • Stretching program and place and in use

  • Knife sharpening program

  • Other

Fall Protection and Protection Program

  • Evaluate harness & lanyards (good condition, proper storage, etc...)

  • Designated anchor points - locations

  • Rail car fall protection systems

  • Safety swing gates in place and operational

  • Ladder storage and usage

  • Other

Fire Prevention

  • Fire sprinkler system operational

  • Sprinkler main valve locked in open position

  • Fire extinguisher inspection current

  • Oil storage area clean

  • Flammable and combustible stored properly

  • Sprinkler heads at least 18 inches from material

  • No smoking signs in applicable places

  • Fire alarms are functional

  • Flammable cabinets in good shape

  • Copy of boiler permits

  • Other

Hot Work Permit Program

  • Designated Welding Area posting

  • Welder condition (welders and leads) -production areas

  • Other

Chemical Handling and Storage

  • Eyewash and shower available & operational - correct activation handle

  • Labeling per Hazcom Program

  • PMs for eyewash and shower

  • Central receiving area

  • Piping labeled and identified

  • Chemical specific SOPs have been developed for receiving, handling, PPE, mixing and storage. SOPs are made available to employees.

  • SDS books - updated

  • Other

Industrial Hygiene

  • H2S monitor required postings or markings

  • Carbon Dioxide "in use" postings

  • Radiation signs markings/postings

  • OSHA hearing conservation posting (designated locations)

  • Evaluate Respirators and cartridges (proper storage)

  • Other

Counter Balances, Chains and Chain Hoists

  • Chain in good shape and stamped

  • Cable in good shape and rated

  • Identified rating on hoist and structure

  • Safety chain or cable in place correctly on all balances (including wizard motors)

  • Safety clip on hoist hook

  • Cable clamp installed properly

  • Other

Lockout Tag-out

  • Lockable valves

  • Lockout procedures posted at drive or available

  • Other

Machine Guarding

  • Shaft key ways smooth

  • No set screws protruding above lock collar

  • Shafts not extended more than one half diameter

  • Sensing mechanism and lid on spinning equipment

  • Auger guarding that requires a tool to remove or interlock that shuts equipment down when lid is raised

  • Sprockets and chains totally enclosed

  • Pulley belt drives totally enclosed

  • Coupling guards covered with safety devices

  • Dual handle controls on scissor type devices

  • Safety shield in place, tongue guard (1/4 inch) and tool rest (1/8 inch) on grinders proper adjusted and mounted securely in place

  • Other

Personal Protective Equipment

  • Evaluate employee PPE - based off of PPE check list

  • Randomly inspect PPE for any defects

  • Other

Knife Handling Program

  • Evaluate transportation of knives

  • Designated location for storage of skinning blades and/or proper transporting

  • Other

PIT Program

  • Evaluate driving at safe distance and speed

  • Cautions/warning signs posted

  • Randomly evaluate PIT license

  • Evaluate daily pre shift inspections

  • SOP for fueling/battery charging -posted in designated locations

  • Loading dock policy posted in load out areas

  • Evaluate PIT for working lights, horns, fire extinguisher, etc

  • Other

Rail car, tanker, hopper safety program

  • Evaluate pedestrian warning systems

  • Other

Vertical Reciprocating Conveyor

  • Evaluate freight lifts (doors, limit switches, etc...)

  • Other

Walking Surfaces, Fixed Stairs, Stairways

  • Floors clean and without obstructions

  • Floor openings that drop more than 4 feet have handrails and toe boards

  • Fixed stairs a minimum of 22 inches unless egress.

  • Fixed stair angle less than 50 degrees

  • Stair railing between 30 and 34 inches

  • Stairwells over 88 inches wide need center handrail

  • Stair treads slip resistant and uniform in height and tread

  • Industrial railing 42 inches with 21 inch intermediate and 4 inch toe board

  • Exits and egress marked clearly

  • Floor drain covers securely in place

  • All floor openings greater than 2 inch by 2 inch have covering

  • Other

Maintenance shops

  • Welding curtain available

  • Housekeeping

  • Air regulators for bench air hoses set at 30 pounds or less

  • Tool rest within 1/8 inch of the abrasive wheel

  • Tongue guard within 1/4 inch of wheel

  • Drill presses, fixed grinders, etc... Securely anchored

  • Oxygen and fuel cylinders separated by fire resistant wall or 25 feet apart

  • Compressed cylinders properly secured

  • Welder condition

  • Torch cart condition (back flow regulators, gauges)

  • Hand tools in safe condition

  • Other


  • Outlying areas (roof, grounds, general production location, etc...)

  • MCC rooms

  • Other

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.