• Audit Title

  • Document No.

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel


  • Business Team

  • Department

Health and Safety Culture

  • Does the business team manager attend the PSRB?

  • Are safety observation tours (SOT) conducted?

  • Are safe operating procedures posted?

  • SPQRCe boards up to date?

  • Employee safety concers being tracked?

Risk Control - Energy Control

  • Performing lockout & test?

  • Personal safety locks?

  • ELC, CAP and ASA placards in place and legible?

  • Using ESWP equipment and tools?

  • Guards in place and secure?

Risk Control - Personal Protective Equipment

  • Head - Hard Hats

  • Eyes - Safety Glasses

  • Hearing - Ear plugs / Muffs

  • Fall Protection (verify annual inspection)

  • Hands & Arms Gloves / Sleeves

  • Legs & Feet - Safety Shoes / Boots

Risk Control - Vehicle Pedestrian Safety

  • Wearing Seat Belts

  • Vehicle Pre-op Inspection?

  • Obeying stop signs?

  • Appropriate use of yellow walkways?

  • Exits / entrances unobstructed?

  • Adhering to Orange Crush Zone requirements (orange vests)?

  • Obeying 2 foot rule with vehicles?

  • No walking and talking on PTT / cell phones?

Risk Control - Fall Protection

  • Wearing fall protection (> 3 m)?

  • Ladder properly positioned and tied off?

  • Fall protection worn in EWP.

Risk Control - Hazardous Materials Program

  • Products labelled appropriately?

  • Products stored properly?

  • Decanted / transferred products labeled?

  • Containers closed?

  • Container grounded?

  • Proper disposal of material?

Workplace Organization

  • Area free of slip and trip hazards?

  • Oil or coolant leaks contained?

  • Tools and equipment in good condition?


  • Auditor's signature

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.