TDIndustries Service Site Audit Form

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Electrical

• Permit

  Yes

  No

  N/A

• PPE<br>

  Safe

  At Risk

  N/A

• Comments / Other Concerns

  Yes

  No

  N/A

Lock Out Tag Out

• Written procedure for multiple energy sources of machine ?

  Yes

  No

  N/A

• Correct Lock out procedures being followed?

  Yes

  No

  N/A

• Comments or Concerns<br>

  Yes

  No

  N/A

PPE

• Issues or Comments

  Safe

  At Risk

  N/A

Ladders and Stairawys

• Issues or Comments

  Safe

  At Risk

  N/A

Company Insured Vehicles

• Issues or Comments

  Safe

  At Risk

  N/A

Chemical Hazards

• SDS

  Safe

  At Risk

  N/A

• Proper PPE

  Safe

  At Risk

  N/A

• Labels

  Safe

  At Risk

  N/A

• Storage

  Safe

  At Risk

  N/A

Equipment

• Qualified Operators

  Safe

  At Risk

  N/A

• Issues or Comments

  Safe

  At Risk

  N/A

Confined Space

• Issues or Comments

  Safe

  At Risk

  N/A

Tools

• Issues or Comments

  Safe

  At Risk

  N/A

Other

• Notes \ Other Concerns

  Yes

  No

  N/A