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
Personnel Placement and Control
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Employee Selection and Placement
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Employee Training
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Supervisor Safety Training and Participation
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Safety Promotion
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Medical Services
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SECTION RATING
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Comments
Hazard Control
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Guards and Warning Devices
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Personal Protective Equipment
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Maintenance of Safeguards and Equipment
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Housekeeping
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Material Handling
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Inspection
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Accident Investigation
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SECTION RATING
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Comments
Occupational Health
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Gas, Vapors, Fumes, Smoke, and Dust
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Dermatitis and Chemical Injuries
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Noise
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Hazardous Materials
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SECTION RATING
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Comments
Property Protection
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Fire and Explosion Prevention
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Fire and Explosion Controls
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Emergency Procedures
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Accident Investigation
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SECTION RATING
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Comments
Fleet Operations
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Selection and Training - Commercial Drivers
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Selection and Training - Incidental Drivers
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Equipment Maintenance
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Operation
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SECTION RATING
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Comments
Completed Operations
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Packaging and Shipping
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Comments
Premises Safety
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Control of Visitors
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On-Premises Exposures
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Off-Premises Exposures
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SECTION RATING
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Comments
Environmental Controls
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Air Pollution
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Water Pollution
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Land Pollution
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SECTION RATING
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Comments
Program Organization and Scope
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Policy
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Safety Program
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Management Support
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Staffing
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Safe Operating Procedures
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Management Attitude and Cooperation
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SECTION RATING
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Comments
Overall Rating
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OVERALLRATING
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Comments
Safety Performance for the Last Three Years
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Employee Injury Frequency Rate Year 1
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Employee Injury Frequency Rate Year 2
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Employee Injury Frequency Rate Year 3
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Serious Injury Frequency Rate Year 1
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Serious Injury Frequency Rate Year 2
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Serious Injury Frequency Rate Year 3
OSHA Inspection Data
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OSHA Inspection Data for the Last ThreeYears
