Title Page

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • Is the pre start checklist completed with all sections completed correctly

  • Is the work site established with barriers and signs erected as required

  • Is all PPE available and being worn correctly including high pressure rated gloves

  • Is the any equipment on the machine that is not to manufacture standards

  • Is the equipment set up as per the work instruction

  • Is the operator able to explain all controls and functions of the machine

  • Does the operator engage and operate the machine as required in the work instruction

  • Is the operator able to explain and identify emergency requirements for various scenarios

  • Is the operator able to explain the daily maintenance for the machine

  • Is the operator able to explain the key hazards of the machine

  • Is the candidate able to explain the process for if the machines hose becomes stuck and reporting faulty equipment

  • Outcome satisfactory

  • Outcome Not Satisfactory

  • Signature of Assessor

  • Signature of Candidate

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.