Audit

START

Do I fully understand the task?

STOP!!!
Speak with your supervisor - you cannot assess a task you do not fully understand.

Does the task involve any of the following?

PTW Required - Enter PTW Number

Is the equipment I am using (including PPE) in good working order and appropriate to task?
(E.g current test and tag, etc.)

STOP!! Don’t use faulty or inappropriate equipment or PPE! (List detail for repair/ correction needed)

Do I have all the necessary (current) training and qualifications to complete the task?

Enter name and rank of competent person supervising

STOP!! Don’t perform work you are not trained/competent/ qualified for!
Speak to your supervisor

Was my task discussed in a Toolbox Talk today?

ENTER TIME OF TBT:

Situational Awareness

1. Can I be caught in, on or between anything?

SUMMARY OF HAZARD CONTROLS:

YOU CAN USE PREVIOUS STEP NUMBERS TO REFER TO CONTROLS ALREADY LISTED!

2. Can I strain or over exert myself? Or will I be working in an awkward position?

SUMMARY OF HAZARD CONTROLS:

YOU CAN USE PREVIOUS STEP NUMBERS TO REFER TO CONTROLS ALREADY LISTED!

3. Can I fall into/ onto/ from anything?

SUMMARY OF HAZARD CONTROLS:

YOU CAN USE PREVIOUS STEP NUMBERS TO REFER TO CONTROLS ALREADY LISTED!

4. Can something fall onto me?
(E.g falling equipment/ projectiles/ mobile plant)

SUMMARY OF HAZARD CONTROLS:

YOU CAN USE PREVIOUS STEP NUMBERS TO REFER TO CONTROLS ALREADY LISTED!

5. Can I slip or trip on anything?

SUMMARY OF HAZARD CONTROLS:

YOU CAN USE PREVIOUS STEP NUMBERS TO REFER TO CONTROLS ALREADY LISTED!

6. Could the work I am doing pose a danger to others?
(e.g. could drop objects/ cause objects to fall/ cause slip, trip or fall hazard/ block emergency exit points or thoroughfare/ cause exposure risk to others?)

SUMMARY OF HAZARD CONTROLS:

YOU CAN USE PREVIOUS STEP NUMBERS TO REFER TO CONTROLS ALREADY LISTED!

7. Are there any objects/equipment/processes that could result in lacerations

SUMMARY OF HAZARD CONTROLS:

YOU CAN USE PREVIOUS STEP NUMBERS TO REFER TO CONTROLS ALREADY LISTED!

8. Are others doing work nearby that could pose a risk to me?
(Including overhead and below deck)

SUMMARY OF HAZARD CONTROLS:

YOU CAN USE PREVIOUS STEP NUMBERS TO REFER TO CONTROLS ALREADY LISTED!

9. Is there a contact or exposure risk?
(e.g. electricity, extreme temperatures, gas, stored energy, hazardous substances, radiation, noise, biological or chemical hazards)

SUMMARY OF HAZARD CONTROLS:

YOU CAN USE PREVIOUS STEP NUMBERS TO REFER TO CONTROLS ALREADY LISTED!

10. Is there a chance I could spill something, or otherwise pollute, damage or disturb the environment?

SUMMARY OF HAZARD CONTROLS:

YOU CAN USE PREVIOUS STEP NUMBERS TO REFER TO CONTROLS ALREADY LISTED!

11. Is there a risk from the weather/sea/working environment/ lighting conditions, which could affect job safety?

Add location

SUMMARY OF HAZARD CONTROLS:

YOU CAN USE PREVIOUS STEP NUMBERS TO REFER TO CONTROLS ALREADY LISTED!

12. Will I be working in a high (damaging) noise area?

SUMMARY OF HAZARD CONTROLS:

YOU CAN USE PREVIOUS STEP NUMBERS TO REFER TO CONTROLS ALREADY LISTED!

13. Are there any other hazards present?

SUMMARY OF HAZARD CONTROLS:

YOU CAN USE PREVIOUS STEP NUMBERS TO REFER TO CONTROLS ALREADY LISTED!

PPE CONTROLS

Is PPE Required according to the matrix, or is listed as hazard control?

Specify Required PPE:

FINISH

(Tick) I have considered my task and believe the controls listed to be effective in allowing me to safely complete my task

Signature
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.