Information

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Which Branch is currently being audited?

  • Location
  • Personnel

  • Branch Manager

Bulletin Board

OSHA poster displayed

  • Verify OSHA poster

  • Corrective Actions

  • Assigned to:

State and Federal Posters Displayed

  • Verify State and Federal posters

  • Corrective Actions

  • Assigned to:

Minimum Wage Poster

OSHA 300 Logs

  • Verify OSHA 300-A displayed (Feb 1 to Apr 30 only)

  • Corrective Actions

  • Assigned to:

  • Verify OSHA 300 Log current

  • Corrective Actions

  • Assigned to:

Record Keeping / Safety Records

OSHA 300 Log (Previous and current-to-date)

  • Is the previous year’s log available

  • Corrective Actions

  • Assigned to:

  • Is this year's log up to date

  • Corrective Actions

  • Assigned to:

Accident Investigation Files

  • Are files current

  • Corrective Actions

  • Assigned to:

  • Are they maintained

  • Corrective Actions

  • Assigned to:

  • Verify Incident log current

  • Corrective Actions

  • Assigned to:

  • Are Incident Investigation Reports completed in a timely manner

  • Corrective Actions

  • Assigned to:

  • Are Safety flashes completed and issued for all incident reports in a timely manner

  • Corrective Actions

  • Assigned to:

Monthly Facility Safety Audit Records

  • Have audits been conducted at least monthly

  • Corrective Actions

  • Assigned to:

  • Have deficiencies been addressed

  • Corrective Actions

  • Assigned to:

Monthly Field Supervisor Site Hazard Audit Records

  • Have Supervisor Hazard audits been conducted at least monthly

  • Corrective Actions

  • Assigned to:

  • Have deficiencies been addressed

  • Corrective Actions

  • Assigned to:

Job Safety Analysis Forms

  • Are they completed properly

  • Corrective Actions

  • Assigned to:

  • Are they audited regularly

  • Corrective Actions

  • Assigned to:

  • Verify JSA's are retained for at least 1 year

  • Corrective Actions

  • Assigned to:

H&S Manual Available & up-to-date

  • Verify safety manual is available and updated as appropriate

  • Corrective Actions

  • Assigned to:

Safety Meeting Records

  • Weekly topics and attendance records are maintained

  • Corrective Actions

  • Assigned to:

  • Monthly Safety meetings recorded and maintained

  • Corrective Actions

  • Assigned to:

  • Monthly supervisor safety meeting recorded and maintained

  • Corrective Actions

  • Assigned to:

Variance Files

  • Variance files maintained and up-to-date

  • Corrective Actions

  • Assigned to:

Corporate Safety Reporting

  • Do Monthly Safety reports get submit on time

  • Corrective Actions

  • Assigned to:

  • Does the meet monthly safety goals

  • Corrective Actions

  • Assigned to:

  • Does the Conduct Monthly Supervisor Safety Meetings

  • Corrective Actions

  • Assigned to:

  • Does the Conduct Monthly Branch Safety Meetings

  • Corrective Actions

  • Assigned to:

  • Does the conduct Weekly Safety Meetings (nested sited)

  • Corrective Actions

  • Assigned to:

Safety Incentive

  • Does the maintain a Safety bucks log

  • Corrective Actions

  • Assigned to:

  • Does the offer any other safety incentives

  • Corrective Actions

  • Assigned to:

Employee Safety Evaluation Cards

  • Does the maintain a record of card completion

  • Corrective Actions

  • Assigned to:

  • Is the higher than 50% completion of cards

  • Corrective Actions

  • Assigned to:

Behavior Based Safety

Job Safety Observations

  • Verify JSO's are completed by (Managers)

  • Corrective Actions

  • Assigned to:

  • Verify JSO's are completed by (Supervisors)

  • Corrective Actions

  • Assigned to:

  • Verify JSO's are completed by (Safety)

  • Corrective Actions

  • Assigned to:

  • Verify JSO's are completed by (Employees)

  • Corrective Actions

  • Assigned to:

Job Safety Observation Log

  • Verify JSO log's are maintained (Monthly)

  • Corrective Actions

  • Assigned to:

Training Records

Training Files

  • Is there a training file for all active employees

  • Corrective Actions

  • Assigned to:

  • Verify copies of training certificates filed with employee training records

  • Corrective Actions

  • Assigned to:

Completed training records up-to-date

  • Verify new-hire training

  • Verify hands on training (if applicable)

  • Verify craft training (if applicable)

Employee Required training Complete

  • Verify required training by training matrix

  • Verify required safety refresher training

  • Verify required craft refresher training (if applicable)

  • Verify Shop Mechanics are Confined Space Trained

  • Verify Shop Mechanics are LOTO Trained (Authorized)

  • Verify all field employees are LOTO Trained (Affected)

  • Verify all field employees have current Pulmonary Function Test

  • Verify all field employees have current Fit Test (Scott AV-2000)

  • Verify all field employees have current Fit Test (3M 7800)

  • Verify all field employees have current Fit Test (3M 5K/6K)

  • Verify all field employees have current Audiogram (Annually)

  • Verify all field employees have current Supplied Air Training

  • Verify all field employees have current Basic Plus

  • Verify all field employees have current Evergreen New Employee Orientation

  • Verify all field employees have current Evergreen Hydro blast & Vacuum Training

  • Verify all field employees have current Hazwoper Training

  • Verify all field employee have fire protection training

  • Verify all field employees have been trained on safe use of fire extinguishers

  • Verify office personnel have fire protection training

  • Verify office personnel have been trained of safe use of fire extinguishers

Training File by Topic Maintained

  • Corrective Actions

  • Assigned to:

  • Are training files kept with original attendance sheets filed by topic

  • Corrective Actions

  • Assigned to:

Corporate Training Programs Implemented

  • Corrective Actions

  • Assigned to:

  • Are corporate training programs being used

  • Corrective Actions

  • Assigned to:

  • Does the Branch have a Certified New Hire Trainer

  • Does the Branch have a Certified Hydro Blast Trainer

  • Does the Branch have a Certified Driver Trainer

  • Does the Branch have a Certified Hazwoper Trainer

  • Does the Branch have a Certified Forklift Trainer

Department of Transportation

Driver Fatigue

  • Verify drivers log Hours of Service

  • Corrective Actions

  • Assigned to:

  • Verify drivers logs audited

  • Corrective Actions

  • Assigned to:

Driver Qualifications

  • Verify all drivers of CMV's have current Driver Qualification files

  • Corrective Actions

  • Assigned to:

  • Verify DQ files current

  • Corrective Actions

  • Assigned to:

  • Verify all drivers of CMV's have current D.O.T Physical Card

  • Corrective Actions

  • Assigned to:

  • Verify all drivers of CMV's have current Driver Test

  • Corrective Actions

  • Assigned to:

  • Verify all drivers of CMV's have current Smith Driver Training

  • Corrective Actions

  • Assigned to:

Equipment Files

  • Does each piece of Equipment assigned to the Branch have an equipment file

  • Corrective Actions

  • Assigned to:

  • Are files formatted properly

  • Corrective Actions

  • Assigned to:

  • Are equipment info sheets completed on all equipment

  • Corrective Actions

  • Assigned to:

  • Verify all equipment has Gross Vehicle Weight (GVW)

  • Corrective Actions

  • Assigned to:

Pre-Trip/DVIR's

  • Are pre trips maintained for previous 90 days

  • Corrective Actions

  • Assigned to:

  • Are work orders completed for pre-trips discrepancies

  • Corrective Actions

  • Assigned to:

  • Verify pre-trips and Work Orders filed in Equipment Files

  • Corrective Actions

  • Assigned to:

Equipment Inspections

  • Have 25% of assets been inspected

  • Corrective Actions

  • Assigned to:

Equipment Maintenance

  • Verify maintenance records backed up on Fleet Mentor

  • Corrective Actions

  • Assigned to:

  • Verify equipment maintenance schedule in place and records current

  • Corrective Actions

  • Assigned to:

Emergency Egress

Site Emergency Action Plan Complete

  • Verify off site muster locations identified

  • Corrective Actions

  • Assigned to:

  • Verify on site muster locations identified

  • Corrective Actions

  • Assigned to:

  • Are quarterly drills conducted and documented

  • Corrective Actions

  • Assigned to:

  • Emergency Action Plan in place and employees trained

  • Corrective Actions

  • Assigned to:

Evacuation Routes Posted

  • Verify evacuation routes are visibly posted

  • Corrective Actions

  • Assigned to:

Exits

  • Verify exit signs are visible all lighted exit signs are lit

  • Corrective Actions

  • Assigned to:

  • Verify interior of exits are not blocked

  • Corrective Actions

  • Assigned to:

  • Verify exterior of exits are not blocked

  • Corrective Actions

  • Assigned to:

  • Verify exit doors are not locked

  • Corrective Actions

  • Assigned to:

  • Doors that are not exits marked "Not A Exit"

  • Corrective Actions

  • Assigned to:

Isles not cluttered

  • Verify that isle ways do not have boxes and other clutter impeding walkways

  • Corrective Actions

  • Assigned to:

Lighting adequate

  • Verify interior lighting is ok in offices and shop areas

  • Corrective Actions

  • Assigned to:

  • Emergency lighting provided if employees work at night or in a windowless building

  • Corrective Actions

  • Assigned to:

Hazard Communication

Site Hazard Communication Plan

  • Verify the site specific information in the Hazard Communication Program is complete

  • Corrective Actions

  • Assigned to:

Containers/labels/tags

  • Verify original containers and labels are marked with name of contents, hazard and manufacturer

  • Corrective Actions

  • Assigned to:

  • Verify secondary containers are marked with contents of container

  • Corrective Actions

  • Assigned to:

  • Verify containers are in good condition

  • Corrective Actions

  • Assigned to:

Chemicals and Waste Properly Stored

  • Verify chemicals, diesel fuel, oils and hydraulic fluids are properly stored

  • Corrective Actions

  • Assigned to:

  • Verify wastes are marked and stored properly

  • Corrective Actions

  • Assigned to:

  • Verify proper containment area is used

  • Corrective Actions

  • Assigned to:

  • Verify area is not cluttered with trash or items not belonging in area

  • Corrective Actions

  • Assigned to:

Combustible materials properly stored

  • Verify combustibles such as oily rags, flammable chemicals, diesel fuel and other materials are not being left sitting around or being stored improperly

  • Corrective Actions

  • Assigned to:

  • Verify area is not cluttered with trash or items not belonging in area

  • Corrective Actions

  • Assigned to:

Spill Kits Available for Clean-up

  • Verify spill kits are available for clean-up

  • Corrective Actions

  • Assigned to:

Fire Protection and Prevention

Fire Extinguisher Locations Marked

  • Verify fire extinguisher locations are properly marked and visible

  • Corrective Actions

  • Assigned to:

  • Verify fire extinguishers are charged and have current fire Marshall annual inspections

  • Corrective Actions

  • Assigned to:

Fire Extinguisher Inspections up-to-date

  • Verify extinguishers are being inspected regularly (monthly)

  • Corrective Actions

  • Assigned to:

Fire Extinguishers Stored in Proper Locations

  • Verify are in correct locations and accessible

  • Corrective Actions

  • Assigned to:

No Smoking Signs Posted

  • Verify “No Smoking Signs” are posted in all applicable areas

  • Corrective Actions

  • Assigned to:

All Areas Free From Fire Hazards

  • Verify fire hazards are not present

  • Corrective Actions

  • Assigned to:

General Shop Area

Housekeeping

  • Corrective Actions

  • Assigned to:

  • General area is free from clutter

  • Corrective Actions

  • Assigned to:

  • Trash cans not overflowing

  • Corrective Actions

  • Assigned to:

  • Workstations clean

  • Corrective Actions

  • Assigned to:

  • Unused tools in their proper place

  • Corrective Actions

  • Assigned to:

Floor free from spills and trip hazards

  • Verify shop floor is free from chemical, oil, diesel or transmission fluid spills

  • Corrective Actions

  • Assigned to:

  • Verify there are no trip hazards caused by extension cords, wiring, flooring, boxes, parts or other material

  • Corrective Actions

  • Assigned to:

Lighting and ventilation adequate

  • Verify lighting in office area is adequate

  • Corrective Actions

  • Assigned to:

  • Verify lighting in shop area is adequate

  • Corrective Actions

  • Assigned to:

  • Verify lighting in storage area is adequate

  • Corrective Actions

  • Assigned to:

  • Verify ventilation in chemical storage area is adequate

  • Corrective Actions

  • Assigned to:

  • Verify ventilation in welding area is adequate

  • Corrective Actions

  • Assigned to:

Machine guards in place and operable

  • All machine guards are in place and being used

  • Corrective Actions

  • Assigned to:

All Applicable Warning Signs in Place

  • Verify hearing protection, goggles required, safety glasses required and other warning signs are in place as appropriate

  • Corrective Actions

  • Assigned to:

Bathroom, kitchen and break areas clean

  • Verify bathrooms are clean and not being used for chemical storage

  • Corrective Actions

  • Assigned to:

  • Verify kitchens are clean and not being used to store chemicals or lab samples

  • Corrective Actions

  • Assigned to:

  • Verify refrigerators are being used for Food Only.

  • Corrective Actions

  • Assigned to:

  • Verify break areas are clean

  • Corrective Actions

  • Assigned to:

Stairways and/or landings properly guarded

  • Verify steps and stairway have hand rails

  • Corrective Actions

  • Assigned to:

  • Verify landings have hand rails, mid-rails and toe-boards as appropriate

  • Corrective Actions

  • Assigned to:

GFCI's

  • GFCI’s are available and being used

  • Corrective Actions

  • Assigned to:

Forklifts

Operator certified

  • Verify forklift operators have a valid certification and is not expired

  • Corrective Actions

  • Assigned to:

  • Equipment is being used as designed.

  • Corrective Actions

  • Assigned to:

  • Deficiencies noted during inspections are being corrected when noted.

  • Corrective Actions

  • Assigned to:

  • Equipment is in good condition.

  • Corrective Actions

  • Assigned to:

Seat belts available and used

  • Verify forklifts are equipped with seatbelts and they are being used

  • Corrective Actions

  • Assigned to:

Fire extinguisher

  • Verify a fire extinguisher is on-board fork lift

  • Corrective Actions

  • Assigned to:

Daily checklist completed

  • Verify the daily check is complete and safety items addressed

  • Corrective Actions

  • Assigned to:

  • Files maintained and up-to-date

  • Corrective Actions

  • Assigned to:

Warning signs posted

  • Verify Forklift warning signs are posted in activity areas

  • Corrective Actions

  • Assigned to:

  • Back-up alarms are operable.

  • Corrective Actions

  • Assigned to:

Yard and Parking Areas

Perimeter fence in good condition

  • Verify fence is in good condition

  • Corrective Actions

  • Assigned to:

Gate in good condition

  • Verify gate is in good condition

  • Corrective Actions

  • Assigned to:

Area free from trip hazards

  • Verify parking areas are free from trip hazards

  • Corrective Actions

  • Assigned to:

No unmarked containers in area

  • Verify there are no unknown packages or containers in area

  • Corrective Actions

  • Assigned to:

  • Verify there are no chemical drums in area

  • Corrective Actions

  • Assigned to:

Equipment parked in orderly manner

  • Verify equipment and vehicles are parked in designated areas

  • Corrective Actions

  • Assigned to:

  • Verify parking areas are free from trip hazards

  • Corrective Actions

  • Assigned to:

QAQC

HOSE TESTING

  • Hose testing done quarterly

  • Corrective Actions

  • Assigned to:

  • Hoses marked with color codes

  • Corrective Actions

  • Assigned to:

  • Hose testing done monthly

  • Corrective Actions

  • Assigned to:

  • Quarterly files being kept

  • Corrective Actions

  • Assigned to:

  • Are high pressure fittings marked correctly

  • Corrective Actions

  • Assigned to:

Fall Protection

  • Does the Branch maintain fall protection properly

  • Corrective Actions

  • Assigned to:

  • Verify fall protection not soiled or damaged

  • Corrective Actions

  • Assigned to:

  • Are harness's and Lanyards of the same manufacturer

  • Corrective Actions

  • Assigned to:

  • Are harness and lanyards inspected quarterly (Competent Person)

  • Corrective Actions

  • Assigned to:

  • Are harness and Lanyards inspected monthly (Visual)

  • Corrective Actions

  • Assigned to:

  • Verify fall protection within life cycle

  • Corrective Actions

  • Assigned to:

PPE

  • Verify employees PPE in good overall condition

  • Corrective Actions

  • Assigned to:

  • Verify employees wearing Z87 eyewear

  • Corrective Actions

  • Assigned to:

  • Verify hardhat are within life cycle

  • Corrective Actions

  • Assigned to:

Body Protection

  • FRC clothing in good overall condition.

  • Corrective Actions

  • Assigned to:

  • Holes in FRC clothing is not larger that a quarter.

  • Corrective Actions

  • Assigned to:

  • FRC Clothing is not excessively soiled w/ oils or paint

  • Corrective Actions

  • Assigned to:

  • FRC Clothing is worn with the zipper up.

  • Corrective Actions

  • Assigned to:

  • Verify employees in compliance with company uniform policy

  • Corrective Actions

  • Assigned to:

Ladder Condition is Ok

  • Verify the ladder is in good condition. No missing or damage wrung's, steps or feet.

  • Corrective Actions

  • Assigned to:

Extension Cords

  • Used properly

  • Corrective Actions

  • Assigned to:

  • In good condition

  • Corrective Actions

  • Assigned to:

  • Verify extension cords are inspected and tested quarterly

  • Corrective Actions

  • Assigned to:

Power Tools

  • Verify power tools are inspected monthly

  • Corrective Actions

  • Assigned to:

  • Verify that all hand power tools are in compliance with the Hand & Power Tool Safety Program

  • Corrective Actions

  • Assigned to:

  • Verify Bench grinders not to exceed 1/4" gap from wheel to adjustable tongue

  • Corrective Actions

  • Assigned to:

Storage

Appropriate PPE Storage Area

  • Verify storage of PPE is acceptable

  • Corrective Actions

  • Assigned to:

  • Verify access to PPE is controlled

  • Corrective Actions

  • Assigned to:

Respiratory Protection

  • Are respirator stored properly

  • Corrective Actions

  • Assigned to:

  • Are respirators maintained by qualified individual

  • Corrective Actions

  • Assigned to:

  • Evidence on respirators being used that employees are not fit tested for

  • Corrective Actions

  • Assigned to:

Storage Rooms (office)

  • Are supplies stored and maintained in an orderly condition

  • Corrective Actions

  • Assigned to:

  • Do employees use material handling devices or get help to move heavy objects

  • Corrective Actions

  • Assigned to:

  • Is a step stool or ladder available to reach high places

  • Corrective Actions

  • Assigned to:

Office

Office Furniture

  • Are desk, chairs, file cabinets, etc., in good condition?

  • Corrective Actions

  • Assigned to:

  • File drawers do not open into hallway or walkway?

  • Corrective Actions

  • Assigned to:

  • File cabinet drawers kept closed when not in use?

  • Corrective Actions

  • Assigned to:

  • File cabinets secured to prevent tip-over when the two upper drawers are open?

  • Corrective Actions

  • Assigned to:

  • Proper stepping stools provided?

  • Corrective Actions

  • Assigned to:

  • Employees trained not to use chairs for stepping stool?

  • Corrective Actions

  • Assigned to:

  • Are desk chairs ergonomically sound & roll smoothly?

  • Corrective Actions

  • Assigned to:

  • Are sharp objects stored where they can’t fall or be handled accidentally?

  • Corrective Actions

  • Assigned to:

  • Employees instructed to call maintenance when file cabinets, heavy objects moved?

  • Corrective Actions

  • Assigned to:

Electrical

  • Electrical power cords in good condition?

  • Corrective Actions

  • Assigned to:

  • Three-prong grounded type plugs on power cords to office equipment where required?

  • Corrective Actions

  • Assigned to:

  • Electrical wall receptacles properly covered?

  • Corrective Actions

  • Assigned to:

  • Are office employees instructed not to make electrical repairs on office equipment?

  • Corrective Actions

  • Assigned to:

  • Identification/marking of circuit breakers noted in circuit breaker panels?

  • Corrective Actions

  • Assigned to:

Aisles, Floors & Stairs

  • Is there a clear aisle way of four feet for two-way traffic within a room or hallway?

  • Corrective Actions

  • Assigned to:

  • Are floors, aisle ways, stairways, and hallways adequately lighted.

  • Corrective Actions

  • Assigned to:

  • Are electrical or telephone outlets in the floor protected by arrangement of furniture of other means to minimize the tripping hazard?

  • Corrective Actions

  • Assigned to:

  • Are carpet edges secure? Curled carpet edges or tears repaired so as to eliminate the tripping hazard?

  • Corrective Actions

  • Assigned to:

  • Do ramps or inclines have non-slip surfaces?

  • Corrective Actions

  • Assigned to:

  • Unusual changes in the walking surface are marked?

  • Corrective Actions

  • Assigned to:

  • Are spills cleaned up as soon as possible? Wet floor signs provided for custodial staff?

  • Corrective Actions

  • Assigned to:

  • Handrails provided on stairways?

  • Corrective Actions

  • Assigned to:

  • Stair treads in good condition?

  • Corrective Actions

  • Assigned to:

Ergonomics

  • Were workstations observed ergonomically correct?

  • Corrective Actions

  • Assigned to:

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.