Title Page

  • Document No.

  • Audit Title

  • Site

  • Conducted on

  • Prepared by

  • Personnel Present

Program Manuals

  • Is There a Minteq SMS Health & Safety Program - US Operations Manual on Hand?

Clarity Net Completion

  • Clarity Net Completion- 25 % Percent Completed Per Quarter <br>

Training Matrix and Corrective Action Tracker

  • Is training Matrix in use and up to date?

  • Is corrective action tracker in use and being maintained?

STOP Card Implementation

  • Are STOP cards being used?

  • Are STOP completion being tracked monthly

Safe Job Procedures

  • Are All Tasks Covered by SJP?

  • Is There a Current Index Available?

  • Is the Review Date Less than 1 Year?

  • Are Employees Reviewing SJP's? One SJP reviewed each week by every employee and are SJP's reviewed by employees documented by Initials or signature?

Safe Job Observations

  • Is one SJO per month per employee being completed? unless shop requirements are different "USS 2 per month" <br>

  • Are SJO being reviewed with employee and documented review with initials or signature? <br>

  • Are you tracking trends and behaviors? <br>

Near Miss Reporting

  • 4 Near misses per employee per shop completed? Are the shops posting near misses reports and the safety board?

OSHA Annual Compliance Requirements

  • Is the Annual PPE Hazard Assessment been completed? Q1

  • Is the Crisis Management Plan updated with teams, contacts, and evacuation routes? Q1

  • Is the annual review of the Crisis Management Plan by all employees documented with initials or signature? Q1

  • Is fall protection training completed and documented with initials or signature? Q2

  • Is there a list of jobs that require fall protection? Q2

  • Is there documented inspections of fall protection equipment? Q2

  • Are annual LO/TO inspections completed with signatures for each piece of equipment or task? Q3

  • Is annual LO/TO training completed and documented with initials or signature? Q3

  • Are all MSDS's on site reviewed annually and documented review with initials or signature? Q4

  • Is Annual Hazcom training documented with initials or signature? Q4

NRTR & R3's

  • Are sites using Non Routine Task Review form?

  • Are shops completing one R3 per month?

Monthly Safety Meeting

  • Are monthly safety meetings documented and signed off by all attending?

Medical Monitoring

  • Are all employees Annual Exams up to date? If not how many are out of date.

Monthly Site Inspection (at least 3/quarter)

  • Are Monthly Site Safety Inspection by Shop Supervisor or DSM completed and documented?

OSHA 300 Log Work-Relate Injury/Illness Reporting

  • OSHA 300 Log form posted 2/1 to 4/30 each year and 5 Years of History

Quarterly Tests on Relief Valves

  • Are test completed quarterly on all tanks and are the results documented?

Standard Work

  • 100% of all employees trained in SW?

  • 100% of all employees participate in a SW event?

  • 100% SW completed for critical processes?

  • 100% of SW completed for other tasks completed?

  • Are bi-weekly review of Standard Work and results documented

  • Is Standard Work Posted at Work Site


  • 2 Kaizen's per Month completed?

  • 100% of all employees have participated in a Kaizen event?

  • Kaizen newspapers or Mini-Kaizen form being used to track events and progress?

  • Action items added to corrective action tracker?


  • TPM events being completed for all equipment? What % completed?

  • Action items from from TPM events added to corrective action tracker?

  • Visual management created for all events?

  • 100% of employees trained in TMP?

Communication Board

  • 5S Map, Jobs, and Areas of Responsibility Posted?

  • 5S Audits (Weekly, Monthly, Quarterly Posted)?

  • Are 5S Before and After Photos Posted and up to date for applicable shops?

  • Are Gemba walks completed daily? Is one documented Gemba walk posted on communications board?

  • Daily Metrics and Tracking Documents Posted (PP/T, Lasers)?

  • Days Without Injury Posted and up to date?

  • Are Safety Alerts Posted and reviewed by all employees?

  • Are visual boards following the OE standard?

Suggestion Board

  • 2 Suggestions per employee per month being collected? Is progress being tracked?

  • Are suggestions being inputted into KMI? And are they being closed out?

Safety Items

  • Are your hazardous chemicals labeled, is their a list of hazardous chemicals for your work area, and are the SDS's available?<br>

  • Do extension cords have grounding conductor, are all cords and cable connections intact, are all extension cords or cables free of splices, and are GFCI's available for use? <br> <br> <br> <br>

  • Are first aid kits and eye wash stations available, inspected, and replenished

  • Are emergency phone numbers posted and easy to find in case of an emergency

  • Are exits properly marked, are they free of obstructions, and are directions to exits posted when not apparent <br> <br> <br>

  • Are approved containers and/or tanks used for storage and handling flammable or combustible liquids, are the containers properly labeled or tagged for contents, and are the storage cabinets labeled "Flammable Keep Fire Away" <br> <br>

  • Are fork-lifts and Minteq equipment being inspected prior to each shift? Are forklifts or Minteq equipment removed from service when not in safe operating condition? Are forklifts inspected daily or before each shift? Do forklifts have flashing lights, horn, overhead guard and nameplate?

  • Are operators licensed? Every three years? Are operator licenses on hand? Performance Evaluation and Training Certificate available? Per SAF-EHS-15 <br>

  • If your operations generate hazardous waste or oil or grease, do you handle it in an approved manner? <br>

  • Are workers protected from sources of excessive noise? Are approved hearing protective equipment available? <br>

  • Are work areas clean and free of debris? Are all work areas adequately illuminated? <br>

  • Is the compressed air for cleaning regulated to less than 30 psi? <br>

  • Is all machinery or equipment capable of movement, required to be de-energized or disengaged and locked out during cleaning, servicing, adjusting or setting up operations, whenever required? Are correct lockout/tagout procedures in use?

  • Are rotating or moving parts of equipment guarded to prevent physical contact? Are all moving chains and gears properly guarded? Are machinery guards secure and so arranged that they do not offer a hazard in their use?

  • Are machinery guards secure and so arranged that they do not offer a hazard in their use? Are power tools used with the correct shield, guard, or attachment recommend by the manufacturer?

  • Are all employees required to use personal protection equipment (PPE) as needed? Is PPE functional and in good repair? Are all employees required to use personal protective equipment (PPE) when handling chemicals (gloves, eye protection, respirators, etc.)?

  • Are appropriate fire extinguishers mounted located and identified so that they are readily accessible (not obstructed) to employees? Are all fire extinguishers inspected monthly and serviced annually, and noted on the inspection tag?

  • Are pits and floor openings covered or otherwise guarded?

Comments or findings

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.