Information

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

CATEGORY A - PERSONAL PROTECTIVE EQUIPMENT

  • EYES AND FACE

  • EARS

  • HEAD

  • HANDS AND ARMS

  • FEET AND LEGS

  • RESPIRATORY SYSTEM

  • TRUNK

CATEGORY B - POSITIONS OF PEOPLESTRIKING

  • STRIKING AGAINST

  • STRUCK BY

  • CAUGHT BETWEEN

  • FALLING

  • TEMPERATURE EXTREMES

  • ELECTRICAL CURRENT

  • INHALING

  • ABSORBING

CATEGORY C - REACTIONS OF PEOPLE

  • ADJUSTING PERSONAL - PROTECTIVE EQUIPMENT

  • CHANGING POSITIONS

  • REARRANGING JOB

  • STOPPING JOB

  • ATTACHING GROUNDS

  • HIDING, DODGING

  • CHANGING TOOLS

CATEGORY D - TOOLS AND EQUIPMENT

  • RIGHT FOR JOB?

  • USED CORRECTLY?

  • IN SAFE CONDITION?

  • SEAT BELTS IN USE?

  • BARRICADES OR WARNING LIGHTS?

  • CHOCKS/RESTRAINTS PROPERLY USED?

CATEGORY E - PROCEDURES

  • IS STANDARD PRACTICE ADEQUATE FOR JOB?

  • IS STANDARD PRACTICE ESTABLISHED?

  • IS STANDARD PRACTICE BEING MAINTAINED?

  • WORK PERMIT PROPER?

  • FIRE WATCH ADEQUATE?

  • GAS TEST (if needed) SATSIFACTORY?

CATEGORY F - ORDERLINESS

  • STANDARDS ESTABLISHED?

  • STANDARDS UNDERSTOOD?

  • OBSTRUCTION IN PASSAGEWAYS

  • DISORGANIZED TOOLS, MATERIALS

  • OBSTRUCTIONS BY STAIRS/PLATFORMS

NOTES

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