Workshop Inspection

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Rating Scale: How Bad is it? What to do

• -1 Dangerous Extreme Potential for Incident / Accident Fix / Control Immediately

• 0 Poor High Potential for Incident / Accident - Nil Compliance Fix / Control immediately

• 1 Fair Medium Potential. Nil to Some compliance Fix within two weeks

• 2 Average Low Potential - Moderate compliance Fix within two months

• 3 Good Low Potential - Mostly in compliance Improve when possible

• 4 Excellent Complies fully with legal, company & site requirements

• N/A* (Not applicable):

1.0 - Previous inspection

• 1.1 - Has the last inspection been reviewed?

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• 1.2 - Are there no outstanding actions?

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

2.0 - Building and Structures

2.1 Lighting

• No lights out/broken

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Sufficient lighting

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Windows clean and undamaged

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

2.2 Ventilation

• Natural air flow and air extraction

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Mechanical (include A/C, fans etc)

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Filters clean/inspected

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Filters clean/inspected • No build up of hazards or flammable material

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

2.3 Amenities

• Adequate supply of drinking water

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Hygienic showers/change rooms

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Cleanliness of fridge and cooking appliances

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Hygienic kitchen/crib room

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Hygienic toilets/urinals

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

2.4 Emergency

• Exits identified

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Exit doors and equipment unobstructed

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Evacuation plan in place

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Emergency lighting

  Yes

  No

  N/A

• Eye Wash clean, accessible & serviceable

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Emergency shower accessible & serviceable

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

2.5 First Aid Facilities

• Clean,

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Fully stocked,

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• First aiders names visible

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Emergency procedure & Numbers visiblea

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

2.6 Fire Protection & Prevention

• Extinguisher Location accessible

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Signs visible

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Signs indicated type of equipment

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Signs to standard

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Current Tags/seals in place

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Condition good

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

2.7 Buildings and Floors

• No building damage

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• No floors damaged/dirty

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Aisles good width, safe & free from obstruction

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Stairs to approved standard - gradient

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Floors good surface, oil free

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

3.0 Housekeeping

3.1 Aisles and Storage

• Good demarcation/ not worn

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Not cluttered/obstructed

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Clear access to emergency equipment & exits

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

3.2 Stacking and Storage

• Racks secure against falling,

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Doesn’t obstruct flow and services

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Sufficient racks/areas for storage

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Clear access and egress

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Load ratings obvious

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

3.3 Wash Down Bay

• Clean

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Pumped out regularly

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Operating instructions on oil separator

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

3.4 Plant and Yard

• No redundant plant

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• No redundant material

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Tidy

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

3.5 Waste / Scrap Removal System

• Sufficient bins

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Adequate removal/emptied

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Waste segregated correctly

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Waste oil from bins captured

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

4.0 Electrical Safeguarding

4.1 Portable Electrical Equipment

• Identified and on register

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• No damaged cables/plugs

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Earthing

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Protection from liquids and dust

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Current inspection tag (> 32v)

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Appropriate storage

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• No visible damaged to tools or electrical leads

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

4.2 Earth Leakage

• Complete coverage – distribution board/temp supply

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Tested regularly by competent person

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Documentation

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Inspection tag

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

4.3 Electrical Installations Safe

• Electrical equipment safe

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Wiring safe

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Unauthorised access to switch gear/substations restricted

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Terminal/distribution cupboards labeled

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Earthing and polarity correct

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• No exposed wires

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• No damage to protective sheath/cable guide or conduit

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

5.0 Plant & Equipment

5.1 Machine Guarding

• Machines comply with appropriate standards

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Guards in place when operating preventing reaching into moving parts

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Guards secure while machine operating

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• interlocks prevent machine operating when open

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• guards protect against hazards to the rear and sides of machines

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• All nip points guarded and signed

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Not loose, broken or inadequate

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

5.2 Bench Grinders, Drills & Saws

• Guards in place & serviceable

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Operating Instructions visible

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Bench grinder wheel condition

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• No damage to saw blades

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Bench grinder tool reset 3mm

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Face shield available &clean (double face protection)

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

5.3 Energy Lock-out System and Usage

• Written procedure

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• positive lock out systems for all power/individually powered systems

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Lockout permits multiple lock outs

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Covers all sources of energy

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• lock out reduces energised equipment to a zero energy state

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Switches lockable

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Tags/locks available

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

5.4 Switches, Isolators, Valves & Controls

• Labeled

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• guarded from damage

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• No labels missing

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Emergency stop buttons red

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Pipes all banded and labeled

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

5.5 Ladders, Handrails and Walkways

• Uprights of ladders not damaged

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Labels of SWL in place

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Rubber footings

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Rungs free from grease/oils

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Metal ladders NOT used for electrical work

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Stairways/landings toe-boards fitted

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Stairways anti slip

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Stairways at least one handrail

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Portable ladders inspected/tested

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Identified and on register

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

5.6 Lifting, Supporting Gear and Machinery

• Identified and on register

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• No defective items

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Standard of Jacks

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Support Stands engineered

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Safe working load marked with MRC * Ref below

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Lifting hook safety latches in place

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Regular inspections and tagged

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Quarantine procedure and disposal

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Stored correctly on rack

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

5.7 Compressed Air

• Air Hoses undamaged

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Air outlets face downwards

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• No air leaks evident

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Safety Clips in place

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Hose adequately secured to fittings

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

6.0 Portable Equipment & Hand tools

6.1 Angle Grinders & Sanders and Buffing Discs

• Guards in place on all rotating tools

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Second handle if fitted

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Dead man switches

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Good mechanical condition – handles/couplings to hold discs on

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• No dust or oil accessing electrics

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• 9” Versions restricted use

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

6.2 Hand tools

• No damaged or defective tools

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Sharp edges covered,

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• mushroomed hammers ends

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• No split handles

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Stored correctly

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Clean of oil & grease

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Soft metal hammers clearly labeled

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

7.0 Gas Cylinders and Pressure Vessels

7.1 Pressure Vessels

• Pressure vessel maintained

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Register/certificates of inspection

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Relief (safety) valve operational

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Drained & free of moisture

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

7.2 Gas Cylinders

• Cylinders correctly stored vertically, secure

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Segregation distance > 3 M

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Equipment safe condition

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Correct flashback arrestors used on hand piece and valves

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Transported correctly, secure

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Stored out of direct sunlight

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

7.3 Connecting pipes fitting and hoses

• In good condition, no leaks, no cracks, no bending at 90 degrees

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Connecting pipes and lines labeled.

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Safety clips used

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

8.0 Mobile Plant & Machines

8.1 Forklift • Condition of Vehicles/Plant

• Daily check/documentation

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• No defective items

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Operator competent

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Isolated when unattended

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Seat belts in use

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Safe Access & Egress

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Fire Extinguisher

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Flashing light/reversing alarm

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Maintenance records

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

8.2 Vehicle

• Condition

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Daily check/documentation

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• No defective items

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Operator competent

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Seat belts in use

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Fire Extinguisher

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• First Aid Kit

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Secured items in rear

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

9.0 Hazardous and Flammable Substances

9.1 Chemicals and Substances

• Chemicals and Substances

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Chemical register

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Manifest and emergency plan

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Products labeled

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• MSDS sheets up to date (Within 5 Years)

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Stored appropriately, bunding & containment

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Segregation distances

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Fumes extracted

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

10.0 PPE & Signage & Notice boards

10.1 Head Protection

• Area identified – sign

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Hard hats provided

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Being worn

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

10.2 Eye and Face Protection

• Area identified – signs

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Equipment provided

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Worn correctly

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

10.3 Hearing Protection

• Area identified –signs

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Equipment provided

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Worn correctly

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

10.4 Other PPE

• Safety harness & lanyards

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Hand protection (gloves etc)

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Respiratory equipment

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Sun protection, Sunscreen

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Sun hat or attachment

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Insect repellent

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Welding PPE

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

10.5 Signage

• Appropriate signs displayed

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• To standard requirements

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Visible & correctly located

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Good condition

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

10.6 Notice Boards

• Conspicuous position

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Suitable size

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Up to date

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Procedure in case of fire

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

• Procedure in case of electric shock

  Select -1 0 1 2 3 4 N/A

  • -1
  • 0
  • 1
  • 2
  • 3
  • 4
  • N/A

Sign Off

• On site representative

  Sign

• Auditor's signature

  Sign

• • Ensure this form is kept live while actions are outstanding.

• • Original form to be kept as a record on site/premises.

• • Findings tabled at Safety / Toolbox Meetings.

• • Copy to Safety department of principal (if applicable)