Information
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Document No.
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Audit Title
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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
Housekeeping
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Check the box if the following are present in working area:
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Spills
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Add media
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Corrective Action
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Cords or other trip hazards
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Add media
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Corrective Action
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Trash/clutter
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Add media
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Corrective Action
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Poor lighting
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Add media
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Corrective Action
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Improper storage of flammables
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Add media
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Corrective Action
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Aisles/walkways kept clear?
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Add media
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Corrective Action
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Work area kept organized?
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Add media
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Corrective Action
Personal Protective Equipment
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Check the box for missing required PPE
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Head
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Add media
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Corrective Action
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Eyes/Face
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Add media
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Corrective Action
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Hands
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Add media
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Corrective Action
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Respiratory
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Add media
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Corrective Action
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Feet
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Add media
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Corrective Action
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Body
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Corrective Action
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Fall Protection (If operations are over 4 ft. high)
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Add media
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Corrective Action
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Fire Resistant clothing/gear
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Add media
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Corrective Action
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All appropriate equipment or gear worn correctly?
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Add media
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Corrective Action
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PPE kept in good condition? (clean no chips, dirt or ripped up)
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Add media
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Corrective Action
Working Position
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Check the box if the following are observed:
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Poor posture
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Add media
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Corrective Action
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Over stretched
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Add media
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Corrective Action
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Above shoulder
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Add media
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Corrective Action
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Below Knees
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Add media
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Corrective Action
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Twisting
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Add media
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Corrective Action
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Caught in between
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Add media
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Corrective Action
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Struck by
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Add media
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Corrective Action
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Working at heights greater than 4'
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Add media
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Corrective Action
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Floor or wall openinig
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Add media
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Corrective Action
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Unprotected work
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Add media
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Corrective Action
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Body position?
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Add media
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Corrective Action
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Location in working environment?
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Add media
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Corrective Action
Tools, Equipment, and Machinery
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Check the box if the following is identified to be IN POOR CONDITION OR UNSAFE:
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Ladders
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Add media
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Corrective Action
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Power or hand tools
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Add media
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Corrective Action
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Machines
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Add media
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Corrective Action
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Equipment
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Add media
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Corrective Action
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Appropriate tools, or machinery and equipment being used?
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Add media
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Corrective Action
Safe Procedures and Safe Behaviors
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Fork lift and crane safe procedures are followed
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Add media
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Corrective Action
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Lockout/Tagout, arc flash, hot work permit, confined space, and/ or departmental specific safety procedures are followed
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Add media
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Corrective Action
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Safe behaviors are observed
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Encouragement Steps
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Corrective Action
