• Audit No.

  • Audit Title

  • Date Performed

  • Employee Audited

  • Audit Location

  • Location
  • Performed by


  • Does the S&C Team Member have current One Line diagram for the electrical system?

  • Was a Tailgate Meeting form completed?

  • Was a Tailgate Meeting form filled out correctly?

  • Did the S&C Team Member obtain job site specific emergency evacuation instructions?

  • Was Method of Procedure used and followed by the S&C Field Service person, if required by the customer?

  • Did the S&C Team Member attend site-specific safety training, if required by the customer?

  • Is the S&C Team Member able to produce hard or soft copy of the S&C Safety Manual?

  • Does the S&C Team Member have the MSDSs available for the materials brought on site?

  • Did the S&C Team Member ask if there are other materials in their work area and if so where to find the MSDSs for those materials?


  • Has the work area been evaluated for hazards, such as, trip/slip hazards and or animal intrusions, etc.?

  • Are cleaning agents, chemicals and other liquids identified and stored in proper containers?

  • Is there an adequate supply of drinking water?


  • Does the S&C Team Member have all the PPE required for the tasks and work conditions, including FR clothing, Safety Glasses, Hard hat, FR Safety Vest, EH safety shoes, insulating rubber goods, gloves, sleeves, matts etc.?

  • Is the Arc Flash clothing in good condition? Free of holes, damage and significant wear and laundered correctly?

  • Are face shields in good condition, free of cracks or significant scratches, and is it stored in a protective bag to prevent damage?<br>

  • Is the S&C Team Member complying with the customer’s PPE requirements, if more stringent than S&C's or OSHA's?

  • Are insulating rubber goods, gloves, sleeves and matts etc., marked with the date they were tested and placed in service?

  • Are insulating rubber goods: gloves, sleeves and matts etc., all within date ranges acceptable for use? If not, note each item individually in the corrective actions section.

  • Are electrical gloves, sleeves and matts etc. stored in their own bags or container, with leather protectors removed, and are not kinked or folded?

  • Has the S&C Team Member confirmed that any third party service providers working for S&C are in compliance with our safety requirements? ​ <br>


  • Before beginning work, has the S&C Team Member removed all jewelry? ​ <br>

  • Can the S&C Team Member explain the Arc Flash boundaries and what they mean?

  • Can the S&C Team Member explain how to determine the Arc Flash values, should the labels be missing?

  • Has the S&C Team Member erected barricades or used barrier tape to establish Arc Flash boundaries, if needed?<br>

  • Has the S&C Team Member communicated LOTO requirements to the customer, if required?

  • Have all stored energy devices like, capacitors, batteries, springs, charging mechanisms, moving machinery parts, hydraulic systems, etc., been discharged, blocked or released?​

  • Have all the required energy sources, electrical & mechanical, been locked out and tagged?

  • Has all of the equipment in the zone of protection been tested for zero energy?​​​ <br>

  • Can the S&C Team Member describe what a "Live - Dead - Live", and how to perform it?

  • Is all testing equipment being used or in the possession of the S&C Team Member calibrated, labeled and has a acceptable calibration date?

  • Are electrical panels covered when not being worked on?

  • Are extension cords in good condition?

  • Does the S&C Team Member have, and if necessary are they using, a Ground Fault Circuit Interrupter (GFCI)?

  • Are all insulated tools present in good condition and free of nicks and in original condition?


  • If the work being performed requires fall protection, is the equipment available, has it been inspected prior to use, and is it being used correctly?


  • If required, did the S&C Team Member get a Hot Work Permit and have a Fire Watch person there and present 60 minutes after completion of the work?


  • Can the S&C Team Member tell you and demonstrate proper lifting practices? <br>1. Straight back<br>2. Test weight of a unknown object before attempting a lift<br>3. No twisting at the waist<br>4. Lift with legs<br>5. Feet staggered and apart to maintain their stability<br>6. Keep load close to body as possible.

  • Did the S&C Team Member insure that their is a clear path before lifting and carrying items?

  • Can the S&C Team Member tell you what maximum safe lifting limit policy is and its limits? ​


  • Is the S&C Team Member certified in First Aid, CPR and AED? ​ <br>First Aid Expiration Date________ CPR Expiration Date________ AED Expiration Date________<br>

  • If certified in First Aid, CPR, and AED can the S&C Team Member produce the training verification card?

  • Blood Borne Pathogens training completed? Date__________

  • Fall Protection training completed? Date_________

  • PPE training completed? Date_________

  • LOTO training completed? Date_________

  • Arc Flash training completed? Date__________

  • Confined Space training completed? Date__________

  • Basic Electrical Safety training completed? Date__________

  • Fire Extinguisher training? ​ Date________

  • Hazard Communication training? Date__________


  • MAJOR NON CONFORMANCE - The S&C Team Member was stopped from working and or removed from the job site. Immediate corrective actions are required.

  • MINOR NON CONFORMANCE- Critical requirements are being met in order to work safely. Minor issue that require follow up are noted.

  • CONFORMING - Meets all requirements and expectations. No follow up required.


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  • S&C Team Member Signature

  • Service Manager

  • Auditor 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.