Worksite Audit

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Clean It employees in area:

• Name of employees:

Permits signed prior to commencing work.

• Permit to Work

  Yes

  No

  N/A

• Confined Space Permit

  Yes

  No

  N/A

• JSEA been completed and signed for the job

  Yes

  No

  N/A

• All isolations and lock outs have been performed.

  Yes

  No

  N/A

• All safety aspects of the job are known and understood

  Yes

  No

  N/A

• Approved barricading, shade cloth and signage in place.

  Yes

  No

  N/A

• Relevant authority informed on arrival.

  Yes

  No

  N/A

• Evacuation procedures for the area are known and understood.

  Yes

  No

  N/A

• Correct PPE for the task is being worn and is in good condition.

  Yes

  No

  N/A

• Housekeeping in work area up to high standard.

  Yes

  No

  N/A

• Inspection of worksite carried out checking for hazards.

  Yes

  No

  N/A

• Hazards or safety concerns for the worksite are as follows:

  Yes

  No

  N/A

• Actions taken over any hazards or safety concerns:

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• Can I do this job safely?

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• Auditor Signature

  Sign