Audit

Audit

Immediate Observation / Imminent Danger?

JHA is complete and accurate

LOTO has been utilized?

Means of disconnect available?

Is van Clean?

Is employee wearing all required PPE?

12 cal suit available?

12 cal suit in good repair?

Fire extinguisher in Vehicle?

First Aid/Body fluid kit in vehicle?

Attach photos of Job

Notes:

Signature of Tech
Inspector signature
Other Signature

Incident Investigation

Incident Investigation

Was there an Incident/Accident or safety Violation

Was there a failure by the Employee to :
Plan
Direct
Organize

Plan

Direct

Organize

Are there indirect causes due to lack of:

Training - Resources - Belief

Training

Resources

Beliefs

Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.