Information

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Program Administration

  • Are there additional incentives for improving safety?

  • Remediation:

  • Is Branch Compliance folder up to date?

  • Remediation:

  • Is Branch currently under Mendoza line?

  • Remediation:

  • Are all accidents/injuries investigated/reported promptly?

  • Remediation:

  • Are all temporary employees utilized and/or trained?

  • Remediation:

DOT Compliance

  • Are drivers off duty 10 hours or more before returning to work?

  • Remediation:

  • Are DOT files complete and up to date?

  • Remediation:

  • Does Branch have a system to maintain medical cards and driver's licenses?

  • Remediation:

  • Are DOT files in locked cabinet or secure location?

  • Remediation:

  • Are VCR's completed daily?

  • Remediation:

  • Are VCR's filed by vehicle for prior 90 days?

  • Remediation:

  • Are drivers on clock less than 60 hours in 7 days?

  • Remediation:

  • Do drivers meet 100 air mile exemption? If not, are logs complete?

  • Remediation:

  • Do CDL holders drive less than 11 hours daily?

  • Remediation:

  • CDL holders do not operate vehicles after 14 hours on the clock?

  • Remediation:

Environmental Compliance

  • Is dust generated or tracked into roadways?

  • Remediation:

  • Is NPDES Stormwater Permit or No Exposure Certification on file?

  • Remediation:

  • Is yard free of standing water?

  • Remediation:

  • Are no elicit discharges detected?

  • Remediation:

  • Are ASTs and associated piping free of rust and obvious damage?

  • Remediation:

  • Are UST system inspections (line tightness, cathode, sumps, etc.) up to date?

  • Remediation:

  • Are ASTs and associated piping free of rust and obvious damage?

  • Remediation:

  • Is UST operator training complete?

  • Remediation:

  • Are UST emergency response contractors and agencies posted?

  • Remediation:

  • Are spill kits available near significant sources?

  • Remediation:

  • Are stormwater ponds permitted and in compliance within maintenance agreement?

  • Remediation:

Employer Postings

  • Is an approved Panel of Physicians posted?

  • Remediation:

  • Is OSHA Job Safety displayed?

  • Remediation:

  • Is OSHA Job Safety displayed?

  • Remediation:

  • Is OSHA 300a posted for the quarter?

  • Remediation:

  • Is "Safety Scoreboard" being used and up to date?

  • Remediation:

Record keeping

  • Are Hepatitis B vaccines completed or declination forms filed?

  • Remediation:

  • Are Hepatitis B vaccines completed or declination forms filed?

  • Remediation:

  • Are permits up to date for air pressure tanks, LPG, etc.?

  • Remediation:

Medical Services and First Aid

  • Are universal precautions observed where BBP exposure can occur?

  • Remediation:

  • Is medical care 3 minutes or 3 miles from workplace or an employee(s) qualified in first aid?

  • Remediation:

  • Are first aid responders trained?

  • Remediation:

  • Are first aid kits accessible, inspected, and replenished as needed?

  • Remediation:

  • Is there an eyewash and/or shower station for quick drenching of the eyes and body?

  • Remediation:

Fire Protection

  • Are fire extinguishers properly located, identified, mounted and accessible?

  • Remediation:

  • Are fire extinguishers inspected monthly and annually?

  • Remediation:

  • Are fire suppression systems inspected manually?

  • Remediation:

  • Are fire suppression systems inspected annually?

  • Remediation:

Personal Protective Equipment

  • Are safety glasses available and worn as needed?

  • Remediation:

  • Are protective gloves or other means provided?

  • Remediation:

  • Are hard hats required, provided, and worn?

  • Remediation:

  • Is appropriate foot protection being worn?

  • Remediation:

  • Is protection against occupational noise provided?

  • Remediation:

  • Do employees working on roadways wear reflective clothing?

  • Remediation:

General Work Environment

  • Are all work areas adequately illuminated?

  • Remediation:

  • Are work areas ventilated appropriately?

  • Remediation:

  • Is all water provided for drinking potable and if not, clearly identified?

  • Remediation:

  • Are all spilled hazardous materials cleaned up immediately?

  • Remediation:

  • Is minimum number of toilet facilities provided and sanitary?

  • Remediation:

Walking Working Surfaces

  • Are floor openings guarded by a cover or guardrail?

  • Remediation:

  • Are aisles and passageways clear and marked?

  • Are aisles and passageways clear and marked?

  • Remediation:

  • Are there standard guardrails where working surfaces are elevated (≥48")?

  • Remediation:

Stairs and Stairways

  • Are signs posted showing elevated surface load capacity?

  • Remediation:

  • Are handrails on stairways and elevated surfaces?

  • Remediation:

  • Are handrails on stairways and elevated surfaces?

  • Remediation:

  • Are all stairways at lease 22" wide and risers uniform?

  • Remediation:

Exit or Egress

  • Are all exits marked and illuminated?

  • Remediation:

  • Are all exits marked and illuminated?

  • Remediation:

  • Are directions to exits, when not apparent, visibly marked?

  • Remediation:

  • Are doors that could be mistake for exits marked "NOT AN EXIT"?

  • Remediation:

  • Are doors that could be mistake for exits marked "NOT AN EXIT"?

  • Remediation:

  • Are all exits kept free of obstructions?

  • Remediation:

  • If exit(s) open into vehicle path are barriers and warnings provided?

  • Remediation:

Hand Tools and Equipment

  • Are all tools and equipment (company & employee's) in good condition?

  • Remediation:

  • Are all tools and equipment (company & employee's) in good condition?

  • Remediation:

Portable (Power Operated) Tools and Equipment

  • Are there guards over belts, pulleys, chains and sprockets on equipment?

  • Remediation:

  • Do portable fans have full guards having openings 1/2 inch or less?

  • Remediation:

  • Is hoisting equipment used? Are ratings marked and appropriate?

  • Remediation:

  • Are power tools used with proper shields, guards, or attachments?

  • Remediation:

  • Are electrically operated tools effectively grounded or double insulated?

  • Remediation:

Abrasive Wheel Grinders

  • Is adjustable tongue (top side) adjusted within 1/4 inch of the wheel?

  • Remediation:

  • Do side guards cover the spindle, nut and flange?

  • Remediation:

  • Are bench and pedestal grinders permanently mounted?

  • Remediation:

  • Are face shields available and/or worn when grinding?

  • Remediation:

  • Do employees changing out abrasive wheels understand ring test?

  • Remediation:

  • Is work rest used and adjusted to within 1/8 inch of wheel?

  • Remediation:

  • Is work rest used and adjusted to within 1/8 inch of wheel?

  • Remediation:

Machine Guarding

  • Fan blades: openings no larger than l/2 inch if within 7 feet of floor?

  • Remediation:

  • Is machinery securely anchored to prevent tipping or movement?

  • Remediation:

  • Can power to each machine be locked out??

  • Remediation:

  • Are all emergency stop buttons colored red?

  • Remediation:

  • Are all pulleys and belts within 7 feet of the floor guarded?

  • Remediation:

  • Are all moving chains and gears properly guarded?

  • Remediation:

Lockout/Tag Out Procedures

  • Is equipment capable of movement, de-energized, blocked & locked out during servicing?

  • Remediation:

  • Can equipment be tagged out if it can't be locked?

  • Remediation:

  • Is stored energy (mechanical, hydraulic, etc.) released or blocked before repairs?

  • Remediation:

  • Are authorized employees certified and provided with individually keyed personal safety locks?

  • Remediation:

  • Can only authorized employee place or remove the safety lock?

  • Remediation:

  • Is there a means to identify all employees working on locked-out equipment?

  • Remediation:

  • Are a sufficient number of tags and safety padlocks provided?

  • Remediation:

Welding, Cutting, Brazing

  • Are empty cylinders appropriately marked and valves closed?

  • Remediation:

  • Are signs posted "NO SMOKING," or the equivalent?

  • Remediation:

  • Are cylinders, valves, regulators & hoses kept free of oily substances?

  • Remediation:

  • When not in use, the valve is closed and gas released?

  • Remediation:

  • Are fire extinguishers available for immediate use?

  • Remediation:

  • Are employees who are exposed to welding & cutting protected with PPE??

  • Remediation:

  • Are cylinders kept away from sources of heat?

  • Remediation:

Compressors and Compressed Air

  • Are belt drive systems totally enclosed?

  • Remediation:

  • When inflating tires, are clip-on chuck and an inline regulator used?

  • Remediation:

  • Are compressed air receivers periodically drained (moisture & oil)?

  • Remediation:

  • Is there a current operating permit?

  • Remediation:

  • Are compressors equipped with pressure relief valves and gauges?

  • Remediation:

  • Are safety devices on compressed air systems checked frequently?

  • Remediation:

  • Are signs posted to warn of the automatic starting of the compressors?

  • Remediation:

Compressed Gas Cylinders

  • Are valve protectors placed on cylinders when not in use?

  • Remediation:

  • Are valves closed when cylinder is empty & at completion of each job?

  • Remediation:

  • Are cylinders legibly marked to identify the type of gas?

  • Remediation:

  • Are fuel gas and oxygen cylinders separated by distance or fire-resistant barriers?

  • Remediation:

  • Are cylinders stored in areas protected from external heat sources?

  • Remediation:

  • Are cylinders securely stored to prevent tipping, damaged or tampering?

  • Remediation:

Hoist and Auxiliary Equipment

  • Are controls plainly marked to indicate the direction of travel or motion?

  • Remediation:

  • Are employees prohibited from using chains or rope slings that are kinked, twisted, or otherwise damaged?

  • Remediation:

  • Is rated load legibly marked and visible to the operator?

  • Remediation:

Industrial Truck- Forklift

  • Are only trained personnel allowed to operate?

  • Remediation:

  • Is warning horn and backup device clearly heard above noise?

  • Remediation:

  • Are inspections done daily and taken out of services if repairs can't be made?

  • Remediation:

Confined Spaces

  • Is lockout tag out always performed prior to confined space entry?

  • Remediation:

  • Are employees prohibited (posted) from entering permitted confined spaces?

  • Remediation:

  • Are all moving parts inside confined spaces locked out and restrained if needed?

  • Remediation:

Flammable and Combustible Materials

  • Are combustible debris and waste materials (oily rags, etc.) stored in covered metal receptacles?

  • Remediation:

  • Are approved containers used to store flammables & combustibles?

  • Remediation:

  • Are "NO SMOKING" signs posted on LPG tanks and where flammable/combustible materials are used or stored?

  • Remediation:

  • Where corrosive liquids are drawn from storage vessels, are adequate means available for neutralizing or disposing of spills or overflows?

  • Remediation:

Hazardous Substances Communication

  • Is there a current hazard assessment on file?

  • Remediation:

  • Is there a list of updated hazardous substances used and MSDS readily available for each used?

  • Remediation:

  • Is there a current written exposure control plan for blood borne pathogens?

  • Remediation:

  • Is there a updated written HazCom program with MSDSs, labeling and training?

  • Remediation:

  • Is RRED ONE Plan in MSDS binder?

  • Remediation:

  • Is each container labeled with product identity and a hazard warning?

  • Remediation:

Electrical

  • In wet or damp locations, is ground fault provided?

  • Remediation:

  • Are all disconnecting switches and circuit breakers labeled?

  • Remediation:

  • Is sufficient access and working space around all electrical equipment?

  • Remediation:

  • Are all unused openings (knockouts) closed with covers or plates?

  • Remediation:

  • Are electrical receptacles, junction boxes, etc., provided with tight-fitting covers?

  • Remediation:

  • Is motor located within sight of its disconnecting means or able to be locked open?

  • Remediation:

  • Are electrical appliances including extension cords grounded?

  • Remediation:

  • Are multiple plug adaptors prohibited?

  • Remediation:

  • Are cords with cursor frayed insulation repaired or replaced promptly?

  • Remediation:

Fueling

  • Are employees prohibited from transferring gasoline in open containers?

  • Remediation:

  • Are open flames, sparking or arcing prohibited near fueling operations?

  • Remediation:

  • Is smoking prohibited near fueling operations?

  • Remediation:

  • Are employees prohibited from fueling while engine is running?

  • Remediation:

  • Are fueling operations performed to minimize spillage?

  • Remediation:

Materials Handling

  • Are dock boards used when loading or unloading between vehicles and docks?

  • Remediation:

  • Are trailers secured from movement (chocked) during loading and unloading?

  • Remediation:

  • Is there safe clearance for equipment through aisles and doorways?

  • Remediation:

Containers

  • Are commercial containers labeled? (“Do Not Play On or Around or Occupy This Container”. “Stand Clear When Container is in Motion”, & “Load Evenly Container must be placed on hard level surface”)

  • Remediation:

  • Are open top containers labeled with maximum loading level?

  • Remediation:

Vehicles

  • Are vehicles in generally good condition?

  • Remediation:

  • Are cabs clean and free of debris or unnecessary equipment?

  • Remediation:

  • Is emergency equipment maintained (20 lbs. of extinguishing agent, 3 reflective triangles, spill kit)?

  • Remediation:

  • Is Safety Lane utilized daily?

  • Remediation:

Closing Comments

  • Add 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.