Information

  • Audit Title

  • Document No.

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • Select date

1.0 PPE Correct

  • 1.1 Hard hat/ bump cap

  • 1.2 Eye/Face Protection

  • 1.3 Hand/Foot Protection<br>

  • 1.4 Hearing Protection

  • 1.5 Clothing/ meets GMP, High Vis

  • Steel toe footwear

2.0 Manual Lifting

  • 2.1 Correct body position

  • 2.2 Help for heavy items

  • 2.3 Hand placement

  • 2.4 Weight known

  • 2.5 Use of equipment

3.0 Line of Fire

  • 3.2 Overhead hazards

  • 3.3. Rotating equipment

  • 3.1 Hand/Body position

  • 3.4 Eyes on work or path

  • 3.5 Pinch/Shard edges identified & protected

4.0 Housekeeping

  • 4.1 Trash/Debris

  • 4.2 Cord/lead control

  • 4.3 Protruding items

  • 4.4 Correct barricades

  • Contractor lot utilization

5.0 Fall protection

  • 5.1 Trip hazard

  • 5.2 Fall arrest equip. use

  • 5.3 Correct ladder use

6.0 Tool Use

  • 6.1 Correct tool

  • 6.2 Used correctly

  • 6.3 Material secured

  • 6.4 Guards in place

  • 6.5 GFCI used

7.0 Equipment/Vehicle Use

  • 7.1 Seat belt use

  • 7.2 Inspection

  • 7.3 Equip. used properly

  • 7.4 Backing

8.0 Adjacent Work

  • 8.1 Equipment startup

  • 8.2 Vehicle traffic

  • 8.3 Work scope known

9.0 Procedures

  • 9.1 Lockout/blinding

  • 9.2 Confined space

  • 9.3 Other procedure<br>

Near misses

  • Any near miss situations to report?

  • Identified parties require retraining?

  • Actions taken?

10.0 Other

  • Item # - What is positive or at risk? / Corrective action or commendation?

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.