Information

  • Document No.

  • Audit Title

  • Conducted on

  • Observed by:

  • Task Observed?

  • Location
  • Personnel

Personal Protective Equipment (Proper Use, Storage, and Maintenance)

  • Hands protected when working with tools, sharp objects, chemicals, hot or cold items?

  • Eyes/face protected from flying debris, chemicals and radiant light. Safety glasses worn in mandatory areas?

  • Head protected from impact from objects above and at same height?

  • Feet protected from impact, puncture, electrical?

  • Ice cleats in use while performing snow removal?

  • Fall protection used properly?

  • Hearing protection used in mandatory areas?

  • Respiratory protection for vapors, dust, misc. debris.

  • Clean shaven, mask stored in sealed container?

Body Position

  • 3 Points of contact while ascending/descending ladders or stairs?

  • Using proper Lifting / Twisting technique?

  • Protected from Line of fire? Caught-in, Struck by, Energy Release

  • Workers keeping hands out of danger zone?

  • Workers staying focused...Eyes on path?

Tools

  • Proper Ladders / Scaffolds / Aerial Lifts being used?

  • Proper equipment Selection / Use the proper tool?

  • Tools in Good Condition / Proper Guarding?

  • GFCI in use with portable equipment?

  • Electrical cords inspected for risks? Protected from damage?

  • Temporary power is being used properly?

  • Flammable materials removed when using electrical tools?

General Safety

  • Housekeeping - Area free of unnecessary materials?

  • Flammable and combustibles stored properly?

  • Ladder/stairways clear of materials and debris?

  • Egress unobstructed?

  • Using handrails on stairways?

  • Surface conditions evaluated and controlled (Ice/Oil/Uneven surfaces??

  • Employees know where the nearest fire extinguisher is?

  • Employees know the emergency procedures?

Other

  • Employees aware of chemical hazards?

  • Radiation controls in place?

  • Employees following work-zone traffic controls for Roadside work?

Lifting Equipment

  • Employees trained and using Overhead cranes / hoists properly?

  • Employees trained and using forklifts properly?

  • Are the Slings / Rigging being used rated for the intended load?

  • Mobile cranes are set up/used correctly?

Construction Area

  • Traffic Control systems constructed appropriately?

  • JHA completed (if needed)?

  • Controls in place while working from heights?

  • Barricades / Signs in place?

  • Permits completed and available (if needed)?

  • Excavation area controlled? Employees using proper trench shoring/shielding?

  • Are employees accessing trench appropriately? (ladders, ramps)

Confined Space Entry

  • Permit completed and posted?

  • Attendant performing his duties only?

  • Air Monitoring being completed?

  • PPE / Emergency Equipment in use?

Lockout / Tagout / Linebreak

  • Employees using personal Locks / Tags?

  • Equipment properly De-energized?

  • Employees have knowledge of Procedure?

  • Proper PPE (Goggles, Face Shield, Gloves for Arc Flash?

Hot Work

  • Permit completed and Posted?

  • Fire watch with extinguisher assigned?

  • Work area free of flammables and combustibles?

  • PPE in use (Welding hood, Screen)?

Vehicle Safety

  • Wheel chocks in place?

  • 3 points of contact while Entering / Leaving Vehicle?

  • Pre trip inspections completed?

  • Proper Loading / Unloading (away from power lines/using hand trucks/lift gates?

  • All loads are secured?

Office Safety

  • Housekeeping?

  • Cords (Electrical Hazards)?

  • Trip hazards?

  • Positive comments / safety topic communicated (provide detail):

  • Opportunities:

  • Signature

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.