Title Page
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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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Select date
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Where are you located?
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What is the job or task that you are reviewing?
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Please state any opening comments about the job or task.
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Please list all completed paperwork.
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Please list all uncompleted paperwork.
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Is everyone on the job using the proper PPE?
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Is Lockout, Tagout, Tryout being implemented correctly?
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Are there employees working in a combined space?
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If yes, please check off each that apply-
- Respiratory Protection
- Protective Clothing
- PPE
- Fire Extinguisher
- Non-Entry Rescue Eqpt
- Lock/Tag/Try
- Ventilation
- Follow-Up Testing
- Other Controls
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Are all tools and equipment compliant?
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Is there hot work being performed?
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If yes, please check off each that apply-
- Lock/Tag/Try
- Ventilation
- Area Secure
- Lighting
- Hotwork Permit
- Fire Extinguishers
- Respirators
- Protective Clothing
- Fire Watch
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Is all housekeeping compliant in the area where work is being performed?
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Is all guarding compliant in the area where work is being performed?
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List any other observations-
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Positive observations-
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Closing comments-
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