Information

  • Conducted on

  • Site Location

  • Name of person audited

  • Region

Safety Performance Standard Key to use of scoring system

  • Ratings
    5 = 80-100% Excellent
    4 = 60-79% Good
    3 = 40-59% Satisfactory
    2 = 20-39% Poor
    1 = 0-19% Unacceptable
    0 = 0% Disaster

Activity

  • 1 Safe Places of work

  • Are there Health & Safety issues or concerns Identified:

  • Health & Safety issues Identified:

  • Comments & Actions Taken:

  • 2 Steps and Ladders

  • Are there Health & Safety issues or concerns Identified:

  • Health & Safety issues Identified:

  • Comments & Actions Taken:

  • 3 Manual Handling

  • Are there Health & Safety issues or concerns Identified:

  • Health & Safety issues Identified:

  • Comments & Actions Taken:

  • 4 Protective Clothing/Equipment

  • Are there Health & Safety issues or concerns Identified:

  • Health & Safety issues Identified:

  • Comments & Actions Taken:

  • 5 Welfare

  • Are there Health & Safety issues or concerns Identified:

  • Health & Safety issues Identified:

  • Comments & Actions Taken:

  • 6 Protecting the Public

  • Are there Health & Safety issues or concerns Identified:

  • Health & Safety issues Identified:

  • Comments & Actions Taken:

  • 7 Plant & Machinery

  • Are there Health & Safety issues or concerns Identified:

  • Health & Safety issues Identified:

  • Comments & Actions Taken:

  • 8 Traffic & Vehicles

  • Are there Health & Safety issues or concerns Identified:

  • Health & Safety issues Identified:

  • Comments & Actions Taken:

  • 9 Fire & Emergency

  • Are there Health & Safety issues or concerns Identified:

  • Health & Safety issues Identified:

  • Comments & Actions Taken:

  • 10 Hazardous Substances

  • Are there Health & Safety issues or concerns Identified:

  • Health & Safety issues Identified:

  • Comments & Actions Taken:

  • 11 Noise

  • Are there Health & Safety issues or concerns Identified:

  • Health & Safety issues Identified:

  • Comments & Actions Taken:

  • 12 Hand Arm Vibration

  • Are there Health & Safety issues or concerns Identified:

  • Health & Safety issues Identified:

  • Comments & Actions Taken:

  • 13 Any other issues identified

  • Health & Safety issues Identified:

  • Comments & Actions Taken:

  • Overall Health and safety Performance Standard

  • Add signature

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