Information

  • Audit Title

  • Client / Site/ Project

  • Conducted on

  • Prepared by

  • Location
  • Document No.

Information

  • Task or equipment I.D.

  • Equipment or Task Photo

  • Location

  • Date and Time JHA Started

  • General Description of Task/s

Sequence of steps

  • Step 1

  • Photo of task

  • Description of task

  • Step Catagory

  • Hazards associated with task

  • PPE Required

  • Controls

  • Summary of controls to reduce or eliminate hazards

  • Step 2

  • Photo of task

  • Description of task

  • Step Catagory

  • Hazards associated with task

  • PPE Required

  • Controls

  • Summary of controls to reduce or eliminate hazards

  • Step 3

  • Photo of task

  • Description of task

  • Step Catagory

  • Hazards associated with task

  • PPE Required

  • Controls

  • Summary of controls to reduce or eliminate hazards

  • Step 4

  • Photo of task

  • Description of task

  • Step Catagory

  • Hazards associated with task

  • PPE Required

  • Controls

  • Summary of controls to reduce or eliminate hazards

  • Step 5

  • Photo of task

  • Description of task

  • Step Catagory

  • Hazards associated with task

  • PPE Required

  • Controls

  • Summary of controls to reduce or eliminate hazards

  • Step 6

  • Photo of task

  • Description of task

  • Step Catagory

  • Hazards associated with task

  • PPE Required

  • Controls

  • Summary of controls to reduce or eliminate hazards

  • Step 7

  • Photo of task

  • Description of task

  • Step Catagory

  • Hazards associated with task

  • PPE Required

  • Controls

  • Summary of controls to reduce or eliminate hazards

  • Step 8

  • Photo of task

  • Description of task

  • Step Catagory

  • Hazards associated with task

  • PPE Required

  • Controls

  • Summary of controls to reduce or eliminate hazards

Jobsite and Task Summary of Analysis

  • Additional Recommendations

Signatures

  • Supervisor

  • Date approved

  • Reviewed

  • EHS Manager

  • Date approved

  • Reviewed

  • Worker

  • Worker

  • Worker

  • Worker

Comments/Discussion

  • General Comments/Discussion

  • Add media

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.