Information
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
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Notice: This audit form should be considered a "living document" and is not all inclusive of those conditions which may be found on site; the template for this form will be updated as needed.
Items marked as N/A are either Not Applicable or Not Observed.
A. Housekeeping
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Work area is clean and free of excess trash and debris
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Walkways and aisles are clear of tripping hazards
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Materials and equipment properly stored
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Scrap metal/wood free of protruding nails and other puncture hazards
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Warning signs posted, work areas barricaded as required
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Presence of restricted beverage containers
B. Personal protective equipment
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Eye protection worn with approved side-shields
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Face shield used as required and attached to hard hat.
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Hardhat worn and bill forward
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Hearing protection worn if required
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Approved footwear
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Approved respirators
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PPE maintained and in good working condition
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Gloves and hand protection
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High-viz vest worn
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Long sleeve shirts worn inside plant
C. Fall protection
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Body harness/double lanyard used properly as required
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Anchorage point capable of supporting 5,000 pounds per employee
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Horizontal lifelines or static lines properly install
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Fall protection equipment in good condition and inspected
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Perimeter/interior railings installed and in good condition
D. Excavations
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Sloped or shored properly based on soil conditions
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Access and egress provided every 25 feet
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Properly barricaded with warning lights
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Inspected daily by competent person
E. Arial lifts, scaffolds and ladders
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Scaffolds erected properly, inspected and tag
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Proper access and egress provide
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Ladder has proper angle and extends 3 feet above landing
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Rope available and used to lift tools and equipment to maintain three-point contact
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Aerial lifts maintained and properly used by trained employees
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Body harness and lanyard used in aerial lifts and incomplete scaffold
F. Hoisting and lifting equipment
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Cranes inspected by qualified person (daily/monthly/annually)
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Cranes used within their capacity with outriggers fully extended
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Load charts available in cab
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Proper rigging selected for task and correctly used
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Chain-falls, come-a-longs and chokers in good working condition
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Softeners used as required
G. Tools and equipment
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Electrical cord sets in good condition with current monthly inspection
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Tools are maintained in good condition
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Proper tools used for the job and in good condition
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GFCIs used as required
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Pneumatic/air hose connections properly secured
H. Fire protection
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Fire extinguishers properly located with current inspection
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Containers stored and labeled properly
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Oxygen and combustibles separated by 20 feet, or 5 foot 1/2 hour rated barriers
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Flashback arrestors are on torch or regulators
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Containment of hot work and welding screens as required
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Firewatch maintained as required
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Hose reels and water cannons maintained
I. Safety planning/permits
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All applicable work permits obtained and posted
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Pre-task plans (PTP) covers tasks adequately and is posted/readily available
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Job safety analysis completed for high hazard or unique tasks
J. Health and environmental
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Spill control in place
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Proper storage and handling of chemicals
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Ventilation is adequate
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MSDS or SDS is available for review by affected employees
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Evacuation/assembly points are known and posted
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Emergency phone number known
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Emergency contact information posted
K. Mobile / Heavy Equipment Operations
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Lights on while operating.
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Daily pre-use inspection performed
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Seat belts worn
Additional observations/findings/comments
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Signed
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