Safety checklist

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Date and Time:

  Date

Contractors

• Contractors On-Site

  Select Boldt Commexi Other

  • Boldt
  • Commexi
  • Other

• Other company name?

• Comments:

Work Activities

• Hot Work

  Yes

  No

• Permit issued

  Yes

  No

• Permit number and description of work being done.

• Take Pictures

  Media

• Immediately stop work and contact Plant Engineer.

• Comments:

• Permit displayed

  Yes

  No

• Permits must be displayed in the area Hot Work is being done.

• Take pictures

  Media

• Comments:

• Permit procedures followed

  Yes

  No

• Immediately stop work and contact Plant Engineer.

• Comments:

• Assembly

  Yes

  No

• Overhead work

  Yes

  No

• Hard hats worn

  Yes

  No

• Proper PPE must be worn

• Comment:

• Work at heights

  Yes

  No

• Fall protection in place

  Yes

  No

• Immediately stop work until proper PPE is worn.

• Comment:

• Other

  Yes

  No

• Comments:

Equipment

• Fork Trucks

  Yes

  No

• Hoist

  Yes

  No

• Crane

  Yes

  No

• Scissor Lift

  Yes

  No

• Fall protection worn

  Yes

  No

• Immediately stop work until proper PPE is worn.

• Comments:

Training

• All personnel trained

  Yes

  No

Personal Protective Equipment

• Hard hats worn

  Yes

  No

• Proper PPE must be worn at all times.

• Comments:

• Eye protection worn

  Yes

  No

  N/A

• Proper PPE must be worn at all times.

• Comments:

• Hearing protection worn

  Yes

  No

• Proper PPE must be worn at all times.

• Comments:

• Foot protection-steel toes

  Yes

  No

• Proper PPE must be worn at all times.

• Comments:

• Hair nets/beard nets

  Yes

  No

• Proper PPE must be worn at all times.

• Comments:

Other

• Signage in place

  Yes

  No

• Comments:

• All work completed in safe manner

  Yes

  No

• Comments:

Corrective Actions

• Comments:

General Observations

• Comments:

• Approvals

  Sign

• Inspector

  Sign