Information
-
Audit Title
-
Client / Site
-
Conducted on
-
Location
-
Date of Inspection
-
Supervisor
-
Safety Rep.
-
Inspected by
-
Insections are
-
ONLY CHECK BOXES BELOW IF ACTION REQUIRED
People
-
Unsafe Acts
-
Work Procedures
-
Tool Use
-
Equipment Use
-
Hard Hats & Safety Footwear
-
Other PPE
-
Following Safety Rules
-
Operator Authorization
-
Protection of Public
-
Smoking in Restricted Areas
-
Evacuation Procedures
-
Lifting Procedures
Equipment/Tools
-
Ladders
-
Scaffolds
-
Power Tools
-
Fall Protection
-
Fire Extinguisher
-
First Aid Supplies
-
Electrical Wiring
-
Lockout/Tagout
-
Vehicle Equipment Condition
-
Traffic Control/Barricades
-
Air Receivers & Compressors
-
Cables, Ropes & Chains
-
Gas Cylinders, Hoses & Regulators
Materials
-
Housekeeping
-
Waste Disposal
-
Controlled Products/WHMIS
-
MSDS Sheets
-
WS&H Act & Regulations
-
Log Books
-
Storage/Stacking
-
Rough Edges
-
Heavy Material
-
Safety Bulletin Board
-
Handling of Pipe
-
Material Storage & Handling
Environment
-
Noise
-
Ventilation
-
Lighting
-
Temperature
-
Ice/Snow
-
Slip/Trip Hazards
-
Sanitation
-
Excavation Procedures
-
Confined Space Entry
-
USE FOLLOWING CHART TO PRIORITIZE CHECKED HAZARDS BELOW
SEVERITY
-
1. Immediate Danger(death,disaster)
-
2. Serious(major injury or damage)
-
3. Minor(non-serious injury or damage)
-
4. Negligible(first aid or less)
-
5. Not Applicable
PROBABILITY
-
A. Probable(immediately or soon)
-
B. Reasonably Probable(eventually)
-
C. Remote(could at some point)
-
D. Extremely Remote(not likely)
Hazard#1
-
Identified Hazard
-
Priority
-
Control
-
Person Taking Action
-
Date of Action Taken
Hazard#2
-
Identified Hazard
-
Priority
-
Control
-
Person Taking Action
-
Date of Action Taken
Hazard#3
-
Identified Hazard
-
Priority
-
Control
-
Person Taking Action
-
Date of Action Taken
Hazard#4
-
Identified Hazard
-
Priority
-
Control
-
Person Taking Action
-
Date of Action Taken
Hazard#5
-
Identified Hazard
-
Priority
-
Control
-
Person Taking Action
-
Date of Action Taken
Hazard#6
-
Identified Hazard
-
Priority
-
Control
-
Person Taking Action
-
Date of Action Taken
Hazard#7
-
Identified Hazard
-
Priority
-
Control
-
Person Taking Action
-
Date of Action Taken
Hazard#8
-
Identified Hazard
-
Priority
-
Control
-
Person Taking Action
-
Date of Action Taken
-
Supervisor
-
Safety Rep.
-
Management
-
Comments
