Information

  • Audit Title

  • Document No.

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

JSA/JHA

  • Performed

  • Appropriate for Task/Task Covered

  • Reviewed

  • Signed

Environmental/Emergency Response

  • Emergency Action Plan

  • Spill Response Kit

  • First-Aid Kit

Hazardous Communication

  • MSDS Available

  • MSDS Reviewed

PPE

  • Hard Hat

  • Eye/Face

  • Hand

  • Hearing

  • Footwear

  • FR clothing

  • Monitors Available, In Use, Calibrated (4-Gas, H2S or Other)

  • Other:

Material Handling

  • Body Mechanics

  • Safety Latch

  • Slings

  • Hooks & Shackles

  • Wire Rope

  • Lifting Chains

  • Tag Lines Used

  • Whip Checks on all soft lines with pressure

Vehicle

  • Authorized/Qualified Operator

  • Seatbelt Used

  • Inspection Completed Properly

  • Loads secured

  • Cab clean and usable

Hand Tools

  • Condition

  • Guards/Handles

  • Proper for Job/Use

Fire Protection & Prevention

  • Fire Suppression Equipment

  • Annual/Monthly Fire Extinguisher Inspection

  • Properly Rated/Size (BC versus ABC)

  • Combustible/Flammable Material Away from Hot Work

Signs/Barricades

  • Condition

  • Proper Type

  • Marking Hazards

Housekeeping

  • Dunnage

  • Trash

  • Trash Receptacles

  • Crew Trucks/Trailers

Walking Surfaces

  • Holes Guarded

  • Pathways

  • Trip Hazards

Media

  • Pictures of the location

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.