Title Page
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Conducted on
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Building/Facility Audited
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Lead EHS Auditor
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Additional EHS Staff Present
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Facility Escort
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General Housekeeping
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Fire Extinguishers: Unobstructed
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Fire Extinguishers: Inspected & Within Date
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Hazardous Material Storage: Secondary Containment
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Hazardous Material Storage: Chemical Compatibility
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Hazardous Material Storage: Labelled Appropriately
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Hazardous Material Storage: Compressed Gas Cylinders Secured During Storage, Use & Transport
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Personal Protective Equipment: Stored Appropriately
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Personal Protective Equipment: Appropriate & Available
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Personal Protective Equipment: Use Communicated & Enforced
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Eyewashes & Safety Showers: Unobstructed
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Eyewashes & Safety Showers: Inspected Weekly
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Eyewashes & Safety Showers: Location & Condition
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Ladder Safety: Appropriate Use
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Ladder Safety: Quarterly Inspection Completed
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Ladder Safety: Manufacturer's Labels Visible
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Electrical Safety: No Daisy-Chaining Extension Cords
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Electrical Safety: Extension Cords in Good Condition
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Slips, Trips & Falls: Workplace Free of Hazards
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Powered Industrial Trucks: Operators Trained & Certified
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Powered Industrial Trucks: Periodic Inspections Performed
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Scissor Lifts & Man-Lifts: Operators Trained
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Scissor Lifts & Man-Lifts: Fall Protection Used
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Hearing Conservation: Area Free of High Noise
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Lock-Out/Tag-Out: Appropriate Use of Locks & Tags Observed
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Lock-Out/Tag-Out: Staff Trained
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Lock-Out/Tag-Out: LOTO Procedures Developed & Implemented for Equipment
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Warning Signage: Appropriate & Consistent
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First Aid Kit: Available & Unexpired
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Emergency Response: Spill Kits Available & Appropriate
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Other Safety Concerns
Acknowledgement
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Signature of Departmental Representative (if present for audit)
