Title Page

  • Client / Site

  • Audit Title

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Plant Data - For Information Only

  • Site Supervisor

  • Assisted during audit by

  • Previous audits?

  • Recent Electrical issues/incidents?

  • Who does electrical Red Books/ maintenance/breakdown support?

  • Who does pump protection (PP) testing? When was last PP online report downloaded?

  • Is Orica site within mine lease?

  • Mining company

  • Type of mine

  • Are electrical panels key locked? If yes, who has a key?

  • Which Mobile units operate out of this site at time of audit?

  • Electrical supply to plant

  • Are the latest versions of electrical drawings available on site?

  • Are the latest versions of electrical drawings recorded in EPDM?

  • RCD Register complete and test records up-to-date?

  • Portable appliance register complete and test records up-to-date?

Top Fatality Risks

  • Have the Top 3 Fatality Risks been identified at site?

  • ACTION: Top 3 Fatalities and controls to be identified.

  • Fatality Risk #1

  • Controls

  • Are the controls in place safe and effective?

  • Fatality Risk #2

  • Controls

  • Are the controls in place safe and effective?

  • Fatality Risk #3

  • Controls

  • Are the controls in place safe and effective?

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.