Information

  • Audit Title

  • Document No.

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

1. High Risk Process Evaluation - answering yes to any question in this section will require the issue of a specific permit.

  • 1.1. Is the work area a confined space?

  • 1.2. Are you undertaking Hot Work (Grinding, Cutting, Welding...)?

  • 1.3. Are you working on live electricity?

  • 1.4. Are you working at height (using steps, ladders, platforms, MEWPs....)?

  • 1.5. Are you working on high pressure air lines?

  • 1.6. Does the work involve exposure or potential exposure to asbestos.

2. Workplace Hazards

  • 2.1. Is there free access and exit from the work area?

  • 2.2. Is access to your work area adequately guarded against unauthorised entry?

  • 2.3. Is the work area free form any hazard which may cause a slip, trip or fall?

  • 2.4. Is the work area free from obstructions and projections?

  • 2.5. Is the work area free from dangers of falling or moving objects?

  • 2.6. Is there enough room to work safely?

  • 2.7. Are dangers from traffic adequately controlled

3. Machinery Hazards

  • 3.1. Has machinery been isolated in such a way that it cannot be inadvertently operated?

  • 3.2. Have all electrical hazards been safely covered?

  • 3.3. Can the task be carried out without removing safety devises (guards, interlocks.....)?

  • 3.4. If not are there safety procedures in place?

  • 3.5. Are you adequately protected from any moving machinery?

  • 3.6. Are you protected / isolated from any extremely hot or cold parts of the machine?

4. Personal Exposure Hazards

  • 4.1. Have all lifting tasks been safely addressed and the required method determined (hoist, 2 man lift......)?

  • 4.2. Are you protected against noise?

  • 4.3. Is there adequate lighting available to carry out the task?

  • 4.4. Are you protected from prolonged exposure to vibration?

  • 4.5. Is the work area free from exposure to high temperature or humidity?

  • 4.6. Do you have the correct tools for the task and are they in a good state of repair?

  • 4.7. Are you protected against any chemical, particles or dust involved in the task?

5. Administrative Controls

  • 5.1. Do you have the correct personal protective equipment (PPE) for the task?

  • 5.2. Has the line operator(s) been informed of the work to be undertaken?

  • 5.3. Do you have the necessary experience and training to undertake the task?

Corrective Actions

  • Enter any corrective actions that will be undertaken

Sign Off

  • On site representative

  • Auditor's signature

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.