Title Page

  • Date

  • Prepared by

  • Location

1 Housekeeping

  • Waste bins emptied

  • Process waste cleared away from machines

  • Special waste cleared

  • Floor areas swept

  • Floor areas clear of debris

  • Unsafe conditions

  • What is the unsafe condition?

  • Provide photo of unsafe condition

  • Slip , trip & fall hazards identified

  • What is the hazard?

  • Provide photo of Hazard

  • Other

2 Fire risks

  • Extinguishers in correct position & unobstructed

  • All signage in place and correct

  • Extinguishers / hose reels within test certificate

  • M.A.C points identified & unobstructed

  • Emergency routes/exits clear

  • Emergency lights operational

  • Debris under machinery/ conveyor lines cleared

  • Other

3 Contractors

  • Induction training provided

  • Risk assesments/method statements available

  • Permits to work for High Risk Activity

  • PPE being worn

  • Unsafe acts / Conditions

  • What is the unsafe act / condition?

  • Photo

  • Other

4 Machinery Isolation and housekeeping

  • Risk assessments in place

  • SSOW in place/ being followed

  • Guards in place

  • Isolation during intervention

  • Unsafe acts/ conditions

  • What is the unsafe act / condition

  • Photo

  • Emergency stops/guards checked

  • Exposed dangerous moving parts

  • What are the dangerous / exposed parts?

  • Photo

  • Machinery clean internally

  • Machinery clean externally

  • Other

5 Electrical

  • Leads trailing the floor

  • Photo

  • PAT – Electrical Appliances

  • Temporary connections

  • What is the temporary connection?

  • Photo

  • Wires exposed / out of shrouding

  • Photo

  • Unsafe conditions

  • What are the unsafe conditions?

  • Photo

  • Other

6 Lift Trucks

  • Operator wearing belts

  • Pre-use inspection completed

  • Lift truck damage

  • What is the damage?

  • Photo

  • Lights operational

  • What lights were not working?

  • Driving Safely

  • What was unsafe?

  • Keys left in FLT

  • Parked safely, securely & not causing obstruction

  • What was unsafe?

  • Photo

  • Other

7 Storage & Warehouse

  • Loads stacked safely and securely

  • Clear access and egress in loading & storage areas

  • Other

8 Work at Height

  • Unsafe acts observed

  • What was the unsafe act?

  • Photo

  • Unsafe conditions seen

  • What were the unsafe conditions?

  • Photo

  • 8.3 Other

9 PPE

  • Mandatory PPE is being worn

  • Storage of PPE

  • Condition of PPE

  • Correctly stored when not in use (prevent contamination)

  • 9.5 Other

10 COSHH

  • Storage of aerosols / Chemicals

  • Essential information available

  • What essential information is missing?

  • Other

11 Signs

  • All signage in place and in good condition

  • All signage clean and clearly visible

  • Other

12 Building Cleanliness

  • Walls, windows and general building support structure

  • Other

13 Behaviour

  • Good Practice

  • Bad Practice Observed

  • What is the bad practice?

  • Other

14 Other

  • First aid/Eye wash available

  • Other

Audit Conclusion

  • Signature of Auditor

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.