Audit

General

Name of casualty

Date
Time

Location

Brief details of accident/incident

Did/could the accident/incident result in significant loss/injury?

Plant and Machinery

Was plant or machinery involved?

If yes, details:

Any defects present?

If yes, details:

Date of last test/inspection

Hazardous Substances

Were any hazardous substances involved?

If yes, details:

Have Material Safety Data Sheets been provided?

Risk Assessment

Has the task or workplace been subject to risk assessments in the following areas?

General

Manual Handling

COSHH

Noise

PPE

Fire Precautions

Other

Give details:

Are the Control Measures identified in the Risk Assessment suitable?

If no, give details:

Have Control Measures been implemented?

If no, give details:

Safety Measures

Have witnesses to the accident/incident been identified?

Please attach Witness Statements to this report

Have their account of the accident/incident been obtained?

Were any contractors' employees involved?

If yes, details:

Have employees received adequate information, instruction, & training to undertake the task safely?

Give details:

Was all equipment needed for the task provided?

Was this equipment being used correctly?

Was there adequate levels of supervision?

Is a Safe System of Work / Safe Working Procedure in place?

Are employees fully aware of the requirements of the Safe Systems/Procedures?

Were any employees not following instructions?

If yes, details:

Safety Inspections

Had the workplace been subject to safety inspections?

If yes, give date & details:

Details of any deficiencies

Hazard Reports

Have hazards relating to the task/workplace been reported?

Give details:

Details of any deficiencies

Working Environment

Were any of the following factors present or extant?

Floors:
Lighting:
Temperature:
Noise levels:
Working space:
Conclusions

Comments:

Photos
Investigated by
Date
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.