Information

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Personal Protective Equipment (PPE)

  • Hard Hats

  • Hearing Protection

  • Respiratory Protection

  • Proper Work Attire

  • Proper Footwear

  • Hand Protection

  • Eye / Face Protection

Housekeeping

  • Access & Egress Clear (Stairs, Isles, Walkways)

  • Material Properly Stacked / Stored

  • Debris / Trash Removal

  • Nails - Bent / Removed

Ladders / Stairs

  • Stair Railings / Hand Rails / Pan Fillers

  • Ladder Condition / Type

  • Secured / Tied Off

  • Extends 3' Above Landing

  • Proper Use / Corral at Top

Fall Protection

  • Guardrail / Mid-Rail / Toe board / Perimeter cable

  • Floor Hole Covers / Secure / Labelled

  • Personal Fall Arrest / Fall Restraint / Proper design / Swing Fall

  • Elevator Shaft Protection / Debris Removed

  • Slips / Trips / Falls

Scaffolding / False Work / Shoring / Decking / Concrete

  • Planks / Decks / Platforms Installed Properly

  • Impalement Protection / Rebar Caps / Troughs

  • Proper Access / Ladder / Inspection

  • Proper Bracing / Re-Shore / Pads

  • Inspected / Secured / Structurally Sound

Electrical

  • Adequate Lighting - Task / Area

  • Grounding / Inspection / GFCI Use

  • Cords Elevated / Receptacles / Plugs / Inspected

  • Lockout / Tagout (LOTO) / Energy Controlled / Rooms Secured / Arc Flash

Fire Protection / Prevention

  • Adequate Extinguishers (Area & Task) / Inspected / Nearby

  • Flammable Materials Storage

  • Proper Welding / Cutting Equipment / Flashback Arrestors

  • Hot Work Permit / Firewatch

Tools - Hand & Power

  • Good Condition / Inspected

  • Guarded / Guards in Place

  • Use Properly / No Modifications

Site / Public Protection

  • Barricading / Fences / Pedestrian Canopy

  • Adequate Signage / Lighting

  • Traffic Control Plan / Flagging

Emergency Preparedness / First Aid

  • Trained Personnel

  • First Aid Kits / Supplies

  • Adequate Sanitation / Hand washing / Water

Programs / Information / Right to Know

  • Periodic Management Inspctions

  • Hazards Properly Identified / Job Hazard Analysis (JHA/AHA)

  • Safety Passport / Orientation / Haz-Com / MSDS / Right to Know

  • Safety / Tool-box Meetings

  • Posting Requirements / Signs

  • Heat Illness Plan / Training / Adequate Water / Shade

Equipment / Crane / Lifts / Hoisting & Rigging

  • Equipment Certifications / Inspections / Alarms / Properly Parked

  • Operator Certification / Qualifications / Seatbelts

  • Lift Plan / Load Swing Planned / Radius Protection / Power lines Identified

  • Rigger / Signal Person Qualifications / Spotter

  • Ground / Area Survey / Stability / No Open Holes / Depressions

Underground / Overhead / Confined Space

  • Active USA / Underground Utilities Marked / Protected Pot-holing

  • Confined Spaces - Identified / Training / Permits

  • Excavations / Trenches - Shoring / Benching / Sloping / Access / PE > 20'

  • Equipment / Material At least 10' from Powelines

Other / Misc.

  • Other / Misc.

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.