Information
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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
Work Environment and Conditions
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Housekeeping and Layout
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Security of equipment
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Barricades and Signage
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Environmental Controls
Systems/Standards/Procedures
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Lock-out and Tag-out
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Work Permits
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Competence for Task
SWMS - Pre Start Checks - MSDS
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Available
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Adequate
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Understood
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Followed
Tools and Equipment
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Condition
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Availability
People and Behaviours
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Are employees Assessing and Re-assessing the area ?
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Are employees maintaining Eyes on Path whilst moving around the worksite ?
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Are employees Looking Before Moving ?
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Are employees selecting appropriate Tools and Equipment and wearing correct PPE ?
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Are employees keeping Eyes on Hands whilst doing works which could result in injury ?
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Are employees ensuring they are not placing themselves in Line of Fire ?
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Are employees Communicating their intent to others ?
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Are employees using correct manual handling techniques to maintain correct Position and Effort ?
Protection systems
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Is electrical equipment positioned appropriately with current test and tag ?
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Are fire extinguishers positioned correctly with clear access and in test and tag ?
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Are hazardous substances used and stored correctly with MSDS available ?
High Risk Activities
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Are Confined Space Entries being carried out in accordance with procedural requirements ?
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Ae Trenching activities being carried out in accordance with legislative requirements ?
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Are activities being carried out On, Over or Near Water being undertaken in a safe manner
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Are employees using appropriate controls for ascending and descending to and from work areas >2mt
POSITIVE OBSERVATIONS
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Note Positive Observations:
AT RISK OBSERVATIONS
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Note Observations to be rectified by WHEN and WHO !
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Provide a sketch of the area of concern if applicable to support findings
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WORKPLACE MANAGER SIGN OFF
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Select date