Company

Accident Incident Hazard Near Miss Procedure

  • Departments audited

  • Question X: Do staff comply with this procedure

  • Corrective Actions

  • Corrective Action
  • Corrective action to take

  • Responsible Person

  • Target Date

  • Closed out date

  • Determine how and when verification will occur.

  • Responsible person

  • Target Date

  • Closed out date

  • Findings

  • Question X: Do supervisors/managers comply with this work instruction

  • Corrective Actions

  • Corrective Action
  • Corrective action to take

  • Responsible Person

  • Target Date

  • Closed out date

  • Determine how and when verification will occur.

  • Responsible person

  • Target Date

  • Closed out date

  • Findings

  • Question X: Do Executive Managers comply with this work instruction

  • Corrective Actions

  • Corrective Action
  • Corrective action to take

  • Responsible Person

  • Target Date

  • Closed out date

  • Determine how and when verification will occur.

  • Responsible person

  • Target Date

  • Closed out date

  • Findings

First Aid Work Instruction

  • Departments audited

  • Question X: Are first aid boxes compliant.

  • Corrective Actions

  • Corrective Action
  • Corrective action to take

  • Responsible Person

  • Target Date

  • Closed out date

  • Determine how and when verification will occur.

  • Responsible person

  • Target Date

  • Closed out date

  • Findings

  • Question X: Are there appropriate numbers of first aid personnel for each shift/site

  • Corrective Actions

  • Corrective Action
  • Corrective action to take

  • Responsible Person

  • Target Date

  • Closed out date

  • Determine how and when verification will occur.

  • Responsible person

  • Target Date

  • Closed out date

  • Findings

Isolation and Tagging Procedure

  • Departments audited

  • Question X: Are staff trained and do they act in compliance with this work instruction.

  • Corrective Actions

  • Corrective Action
  • Corrective action to take

  • Responsible Person

  • Target Date

  • Closed out date

  • Determine how and when verification will occur.

  • Responsible person

  • Target Date

  • Closed out date

  • Findings

  • Question X: Are appropriate tags available for use.

  • Corrective Actions

  • Corrective Action
  • Corrective action to take

  • Responsible Person

  • Target Date

  • Closed out date

  • Determine how and when verification will occur.

  • Responsible person

  • Target Date

  • Closed out date

  • Findings

JSA Risk Assessment Procedure

  • Departments audited

  • Question X: Are risk assessments being completed where/when required.

  • Corrective Actions

  • Corrective Action
  • Corrective action to take

  • Responsible Person

  • Target Date

  • Closed out date

  • Determine how and when verification will occur.

  • Responsible person

  • Target Date

  • Closed out date

  • Findings

  • Question X: Are risk assessments being completed where/when required.

  • Corrective Actions

  • Corrective Action
  • Corrective action to take

  • Responsible Person

  • Target Date

  • Closed out date

  • Determine how and when verification will occur.

  • Responsible person

  • Target Date

  • Closed out date

  • Findings

  • Question X: Is the required documentation compliant

  • Corrective Actions

  • Corrective Action
  • Corrective action to take

  • Responsible Person

  • Target Date

  • Closed out date

  • Determine how and when verification will occur.

  • Responsible person

  • Target Date

  • Closed out date

  • Findings

Manual Handling and Lifting Safe Work Instruction

  • Departments audited

  • Question X: Can employees demonstrate the correct way to lift.

  • Corrective Actions

  • Corrective Action
  • Corrective action to take

  • Responsible Person

  • Target Date

  • Closed out date

  • Determine how and when verification will occur.

  • Responsible person

  • Target Date

  • Closed out date

  • Findings

Mobile Electronic Device Work Instruction

  • Departments audited

  • Question X: Do staff comply with the Work Instruction

  • Corrective Actions

  • Corrective Action
  • Corrective action to take

  • Responsible Person

  • Target Date

  • Closed out date

  • Determine how and when verification will occur.

  • Responsible person

  • Target Date

  • Closed out date

  • Findings

PPE Work Instruction

  • Departments audited

  • Question X: Do staff comply with the work instruction

  • Corrective Actions

  • Corrective Action
  • Corrective action to take

  • Responsible Person

  • Target Date

  • Closed out date

  • Determine how and when verification will occur.

  • Responsible person

  • Target Date

  • Closed out date

  • Findings

  • Question X: Is all required PPE available for workers.

  • Corrective Actions

  • Corrective Action
  • Corrective action to take

  • Responsible Person

  • Target Date

  • Closed out date

  • Determine how and when verification will occur.

  • Responsible person

  • Target Date

  • Closed out date

  • Findings

  • Question X: Do all contractors and visitors comply with this work instruction

  • Corrective Actions

  • Corrective Action
  • Corrective action to take

  • Responsible Person

  • Target Date

  • Closed out date

  • Determine how and when verification will occur.

  • Responsible person

  • Target Date

  • Closed out date

  • Findings

Engineering

  • Was the previous Engineering safety audit closed out

General

  • From the drop down list provided select which Work Instruction(s) you will use to verify this question.

  • Question X: Were the steps in the selected work instruction(s) current and followed by staff.

  • Corrective Actions

  • Corrective Action
  • Corrective action to take

  • Responsible Person

  • Target Date

  • Closed out date

  • Determine how and when verification will occur.

  • Responsible person

  • Target Date

  • Closed out date

  • Findings

Asbestos Management

  • Question X: Is the Asbestos Management Plan & Asbestos Register current?

  • Corrective Actions

  • Corrective Action
  • Corrective action to take

  • Responsible Person

  • Target Date

  • Closed out date

  • Determine how and when verification will occur.

  • Responsible person

  • Target Date

  • Closed out date

  • Findings

  • Question X: Have all identified action/recommendations identified in the Asbestos Management Plan & Asbestos Register been addressed?

  • Corrective Actions

  • Corrective Action
  • Corrective action to take

  • Responsible Person

  • Target Date

  • Closed out date

  • Determine how and when verification will occur.

  • Responsible person

  • Target Date

  • Closed out date

  • Findings

Lifting Equipment Inspections

  • Question X: Is any non-approved lifting equipment in use.

  • Corrective Actions

  • Corrective Action
  • Corrective action to take

  • Responsible Person

  • Target Date

  • Closed out date

  • Determine how and when verification will occur.

  • Responsible person

  • Target Date

  • Closed out date

  • Findings

  • Question X: Is all lifting equipment recorded, inspected and marked as per the Work Instruction

  • Corrective Actions

  • Corrective Action
  • Corrective action to take

  • Responsible Person

  • Target Date

  • Closed out date

  • Determine how and when verification will occur.

  • Responsible person

  • Target Date

  • Closed out date

  • Findings

Permit to Work

  • From the drop down list provided select which Work Instruction(s) you will use to verify this question.

  • Question X: Do contractors comply with the work instruction

  • Corrective Actions

  • Corrective Action
  • Corrective action to take

  • Responsible Person

  • Target Date

  • Closed out date

  • Determine how and when verification will occur.

  • Responsible person

  • Target Date

  • Closed out date

  • Findings

  • Question X: Do managers/supervisors comply with the work instruction(s)

  • Corrective Actions

  • Corrective Action
  • Corrective action to take

  • Responsible Person

  • Target Date

  • Closed out date

  • Determine how and when verification will occur.

  • Responsible person

  • Target Date

  • Closed out date

  • Findings

Traffic Management Plan

  • Question X: Is the Traffic Management Plan current and observed by site users.

  • Corrective Actions

  • Corrective Action
  • Corrective action to take

  • Responsible Person

  • Target Date

  • Closed out date

  • Determine how and when verification will occur.

  • Responsible person

  • Target Date

  • Closed out date

  • Findings

Vehicle and Mobile Plant

  • Question X: Is maintenance for trucks and other mobile plant completed as per schedules and records maintained.
    Note: Must audit 3 x trucks, 2 x reach or yard forklift, 2 x PR/PE/electric walk jack.

  • Corrective Actions

  • Corrective Action
  • Corrective action to take

  • Responsible Person

  • Target Date

  • Closed out date

  • Determine how and when verification will occur.

  • Responsible person

  • Target Date

  • Closed out date

  • Findings

  • Question X: Do Sealanes staff comply with the Vehicle - Maintenance Reporting Perth Metro Work Instruction

  • Corrective Actions

  • Corrective Action
  • Corrective action to take

  • Responsible Person

  • Target Date

  • Closed out date

  • Determine how and when verification will occur.

  • Responsible person

  • Target Date

  • Closed out date

  • Findings

Transport

  • Was the previous Transport safety audit closed out

General

  • From the drop down list provided select which Work Instruction(s) you will use to verify this question.

  • Question X: Were the steps in the selected work instruction(s) current and followed by staff.

  • Corrective Actions

  • Corrective Action
  • Corrective action to take

  • Responsible Person

  • Target Date

  • Closed out date

  • Determine how and when verification will occur.

  • Responsible person

  • Target Date

  • Closed out date

  • Findings

Driver Fatigue

  • Question X: Are the steps in the Driver Fatigue Management Plan current and followed by supervisor's/managers.

  • Corrective Actions

  • Corrective Action
  • Corrective action to take

  • Responsible Person

  • Target Date

  • Closed out date

  • Determine how and when verification will occur.

  • Responsible person

  • Target Date

  • Closed out date

  • Findings

  • Question X: Are the steps in the Driver Fatigue Operating Standards and Procedure current and followed by drivers.

  • Corrective Actions

  • Corrective Action
  • Corrective action to take

  • Responsible Person

  • Target Date

  • Closed out date

  • Determine how and when verification will occur.

  • Responsible person

  • Target Date

  • Closed out date

  • Findings

Vehicle

  • Question X: Do Sealanes staff comply with the Tail Lift Operating Work Instruction.

  • Corrective Actions

  • Corrective Action
  • Corrective action to take

  • Responsible Person

  • Target Date

  • Closed out date

  • Determine how and when verification will occur.

  • Responsible person

  • Target Date

  • Closed out date

  • Findings

  • Question X: Do Sealanes staff comply with the Vehicle - Breakdown and Accident Work Instruction.

  • Corrective Actions

  • Corrective Action
  • Corrective action to take

  • Responsible Person

  • Target Date

  • Closed out date

  • Determine how and when verification will occur.

  • Responsible person

  • Target Date

  • Closed out date

  • Findings

  • Question X: Do Sealanes staff comply with the Vehicle - Maintenance Reporting Perth Metro Work Instruction

  • Corrective Actions

  • Corrective Action
  • Corrective action to take

  • Responsible Person

  • Target Date

  • Closed out date

  • Determine how and when verification will occur.

  • Responsible person

  • Target Date

  • Closed out date

  • Findings

  • Question X: Do Sealanes staff comply with the Vehicle - Safe Entry and Exit of Trucks Work Instruction.

  • Corrective Actions

  • Corrective Action
  • Corrective action to take

  • Responsible Person

  • Target Date

  • Closed out date

  • Determine how and when verification will occur.

  • Responsible person

  • Target Date

  • Closed out date

  • Findings

  • Question X: Are all the vehicle work instructions current.

  • Corrective Actions

  • Corrective Action
  • Corrective action to take

  • Responsible Person

  • Target Date

  • Closed out date

  • Determine how and when verification will occur.

  • Responsible person

  • Target Date

  • Closed out date

  • Findings

W/House Day

  • Was the previous Warehouse Day shift safety audit closed out

General

  • From the drop down list provided select which Work Instruction(s) you will use to verify this question.

  • Question X: Were the steps in the selected work instruction(s) current and followed by staff.

  • Corrective Actions

  • Corrective Action
  • Corrective action to take

  • Responsible Person

  • Target Date

  • Closed out date

  • Determine how and when verification will occur.

  • Responsible person

  • Target Date

  • Closed out date

  • Findings

Working at Height

  • Question X: Do Sealanes staff comply with the Working at Height Work Instruction

  • Corrective Actions

  • Corrective Action
  • Corrective action to take

  • Responsible Person

  • Target Date

  • Closed out date

  • Determine how and when verification will occur.

  • Responsible person

  • Target Date

  • Closed out date

  • Findings

  • Question X: Do Sealanes staff comply with the Working at Height (Palmyra) Rescue Procedure and Plan

  • Corrective Actions

  • Corrective Action
  • Corrective action to take

  • Responsible Person

  • Target Date

  • Closed out date

  • Determine how and when verification will occur.

  • Responsible person

  • Target Date

  • Closed out date

  • Determine how and when verification will occur.

  • Responsible person

  • Target Date

  • Closed out date

  • Findings

  • Question X: Are all rescue team members trained.
    Note: Check training register and ask 3 people on the rescue team what their duties are.

  • Corrective Actions

  • Corrective Action
  • Corrective action to take

  • Responsible Person

  • Target Date

  • Closed out date

  • Findings

  • Question X: Are the work instructions current.

  • Corrective Actions

  • Corrective Action
  • Corrective action to take

  • Responsible Person

  • Target Date

  • Closed out date

  • Determine how and when verification will occur.

  • Responsible person

  • Target Date

  • Closed out date

  • Findings

W/House Night

  • Was the previous Warehouse Night shift safety audit closed out

General

  • From the drop down list provided select which Work Instruction(s) you will use to verify this question.

  • Question X: Were the steps in the selected work instruction(s) current and followed by staff.

  • Corrective Actions

  • Corrective Action
  • Corrective action to take

  • Responsible Person

  • Target Date

  • Closed out date

  • Determine how and when verification will occur.

  • Responsible person

  • Target Date

  • Closed out date

  • Findings

Working at Height

  • Question X: Do Sealanes staff comply with the Working at Height Work Instruction

  • Corrective Actions

  • Corrective Action
  • Corrective action to take

  • Responsible Person

  • Target Date

  • Closed out date

  • Determine how and when verification will occur.

  • Responsible person

  • Target Date

  • Closed out date

  • Findings

  • Question X: Do Sealanes staff comply with the Working at Height (Palmyra) Rescue Procedure and Plan

  • Corrective Actions

  • Corrective Action
  • Corrective action to take

  • Responsible Person

  • Target Date

  • Closed out date

  • Determine how and when verification will occur.

  • Responsible person

  • Target Date

  • Closed out date

  • Determine how and when verification will occur.

  • Responsible person

  • Target Date

  • Closed out date

  • Findings

  • Question X: Are all rescue team members trained.
    Note: Check training register and ask 3 people on the rescue team what their duties are.

  • Corrective Actions

  • Corrective Action
  • Corrective action to take

  • Responsible Person

  • Target Date

  • Closed out date

  • Findings

  • Question X: Are the work instructions current.

  • Corrective Actions

  • Corrective Action
  • Corrective action to take

  • Responsible Person

  • Target Date

  • Closed out date

  • Determine how and when verification will occur.

  • Responsible person

  • Target Date

  • Closed out date

  • Findings

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