• Audit Title

  • Document No.

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Work Area Preperation

  • Lockout/Tagout procedures correct

  • Confined Space Entry: permits posted, etc.

  • Hot Work Permit: Permit posted, etc.

  • Spills and Slippery Surfaces: Identified and corrected

  • Tripping Hazards: Identified and corrected

  • Housekeeping: Area picked up and clean for safe work

  • Guards and Barriers: In place and working


  • Head Protective: Hard hats in use with overhead work

  • Eye and Face Protection: safety glasses and faceshield

  • Hearing Protection: In required areas

  • Hand Protection: Moving material, using knives etc.

  • Arm Protection: When using knives, chemical use etc.

  • Foot Protection: Wearing required steel toed shoes

  • Body Protection: When working w/ acids, chemicals etc

  • Respiratory Protection: When required

  • Fall Protection: When falls of 6' or greater, ladder use

Body Mechanics and Ergonomics

  • Lifting/Carrying/Pulling/Pushing: Body movement

  • Line of Fire: Body location, regarding machine ops.

  • Pinch Point: Body location between objects.

  • Path of Travel: Body location between equipment

  • Path of Travel: Climbing from one elevation to next

  • Path of Travel: Flat surface

Tools and Equipment

  • Selection: Proper tool or equipment for job

  • Condition: Tools & equipment in safe conditions for use

  • Use: Tools & equipment being used as intended

  • Mobile Equipment: Inspected prier to use, safe ops.

Follow Up

  • Is follow up required

  • Add media

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.