Stop Audit

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Area

  Select Cut Block Loader Operator Office Bagged Ice Box Repair Maintenance Driver B-Cut

  • Cut Block
  • Loader
  • Operator
  • Office
  • Bagged Ice
  • Box Repair
  • Maintenance
  • Driver
  • B-Cut

Reaction of People

• Adjusting PPE

  Safe

  At Risk

  N/A

• Changing Position

  Safe

  At Risk

  N/A

• Rearranging Job

  Safe

  At Risk

  N/A

• Stopping Job

  Safe

  At Risk

  N/A

• Attaching Grounds

  Safe

  At Risk

  N/A

• Performing Locks

  Safe

  At Risk

  N/A

• Comments

Personal Protective Equipment and Quality Protective Equipment

• Bump Cap

  Safe

  At Risk

  N/A

• Steel Toe Boots

  Yes

  No

  N/A

• Safety Glasses

  Safe

  At Risk

  N/A

• Ear Plugs

  Safe

  At Risk

  N/A

• Respiratory System

  Safe

  At Risk

  N/A

• Apron or Smock

  Safe

  At Risk

  N/A

• Hair Net

  Yes

  No

  N/A

• Beard Net

  Yes

  No

  N/A

• Comments

Positions of People

• Striking against or struck by objects

  Safe

  At Risk

  N/A

• Caught in, on, or between objects

  Safe

  At Risk

  N/A

• Falling

  Safe

  At Risk

  N/A

• Contacting Extreme Temperatures

  Safe

  At Risk

  N/A

• Contacting electrical current

  Safe

  At Risk

  N/A

• Inhaling, absorbing, or swallowing a hazardous substance

  Safe

  At Risk

  N/A

• Repetitive Motions

  Safe

  At Risk

  N/A

• Awkward positions, static postures

  Safe

  At Risk

  N/A

• Comments

Tools

• Right for the job

  Safe

  At Risk

  N/A

• Used Correctly

  Safe

  At Risk

  N/A

• In good condition

  Safe

  At Risk

  N/A

• Comments

Procedures

• Available

  Safe

  At Risk

  N/A

• Adequate

  Safe

  At Risk

  N/A

• Known

  Safe

  At Risk

  N/A

• Understood

  Safe

  At Risk

  N/A

• Followed

  Safe

  At Risk

  N/A

• Comments

Orderliness

• Known Order

  Safe

  At Risk

  N/A

• Understood order

  Safe

  At Risk

  N/A

• Followed Order

  Safe

  At Risk

  N/A

• Comments

Observation Report

Safe Acts

• What safe acts were observed?

• What actions were taken to encourage safe performance

Unsafe Acts

• What unsafe acts were observed?

• What corrective action was taken?

• What action was taken to prevent further occurance?