Information
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Audit Title
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Document No.
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
JSA/JHA
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Performed
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Appropriate for Task/Task Covered
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Reviewed
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Signed
Environmental/Emergency Response
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Emergency Action Plan
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Spill Response Kit
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First-Aid Kit
Hazardous Communication
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MSDS Available
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MSDS Reviewed
PPE
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Hard Hat
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Eye/Face
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Hand
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Hearing
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Footwear
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FR clothing
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Monitors Available, In Use, Calibrated (4-Gas, H2S or Other)
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Other:
Material Handling
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Body Mechanics
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Safety Latch
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Slings
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Hooks & Shackles
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Wire Rope
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Lifting Chains
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Tag Lines Used
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Whip Checks on all soft lines with pressure
Vehicle
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Authorized/Qualified Operator
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Seatbelt Used
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Inspection Completed Properly
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Loads secured
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Cab clean and usable
Hand Tools
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Condition
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Guards/Handles
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Proper for Job/Use
Fire Protection & Prevention
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Fire Suppression Equipment
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Annual/Monthly Fire Extinguisher Inspection
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Properly Rated/Size (BC versus ABC)
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Combustible/Flammable Material Away from Hot Work
Signs/Barricades
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Condition
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Proper Type
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Marking Hazards
Housekeeping
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Dunnage
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Trash
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Trash Receptacles
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Crew Trucks/Trailers
Walking Surfaces
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Holes Guarded
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Pathways
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Trip Hazards
Media
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Pictures of the location