Quality Air Service Safety Inspection form

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

undefined

• Good

  Fair

  Poor

  N/A

• Are lockout tagout procedures in place and in use when required? Is there a lockout tagout kit including locks and tags available for use?

  Yes

  No

  N/A

• Was a 5x5 conducted and what was it? List the answer below.<br>

  Yes

  No

  N/A

• Are all work sites adequately illuminated?

  Yes

  No

  N/A

• Is fall protection provided and in use when required?

  Yes

  No

  N/A

• Are pits, floor openings and holes covered or otherwise guarded?

  Yes

  No

  N/A

• Are safety gloves (ANSI Cut level 4) used on site and as required while performing work?

  Yes

  No

  N/A

• Are hard hats or bump caps provided and in use as required? <br>

  Yes

  No

  N/A

• Are safety glasses and face shields (or goggles) on site and used when necessary?<br>

  Yes

  No

  N/A

• Are safety vests or high visibility shirts used on site and used when necessary?

  Yes

  No

  N/A

• Are all work sites clean, sanitary and orderly?

  Yes

  No

  N/A

• Are walking and working surfaces properly guarded when exposure to fall is present?

  Yes

  No

  N/A

• Are all extension cords in good condition, properly grounded, equipped with ground plugs, and used for temporary applications?

  Yes

  No

  N/A

• Are all ladders free from defects, properly labeled, approved and used as intended?

  Yes

  No

  N/A

• Are all tools and equipment used by employees in good condition?

  Yes

  No

  N/A

• Are employees aware of the hazards caused by fault or improperly used hand tools?

  Yes

  No

  N/A

• Is personal protective equipment inspected and in good condition?

  Yes

  No

  N/A

• Is protection against the affects of occupational noise exposure provided and used?

  Yes

  No

  N/A

• Any additional comments?

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