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SAFETY AUDIT

Date _________________ Owners Representative____________________________________ Auditor_________________________________

Contractor ______________________________________________ Project____________________________________________________

This is intended only as a reminder. Look for other unsafe acts and conditions, and then report them so that corrective action can be taken. Note

accurately whether unsafe acts or conditions that have caused accidents have been corrected. Note also whether potential accident causes, markedon previous inspection have been corrected. Follow-up where required. Note unsafe act and action taken in comment section on back of sheet.

Rating Scale 1 2 3 4 5

Unsatisfactory Satisfactory Excellent N/A (Not Applicable)

1) Safety Plan

Is Safety Plan on File 1 2 3 45

Are key elements of plan posted 1 2 3 45

2) Safety Orientation & Training

Awareness of Safety Plan 1 2 3 45

Awareness of Plant Safety Rules 1 2 3 45

Awareness of Emergency Procedures 1 2 3 4

5 Pre-task orientation 1 2 3 4 5

3) Substance Abuse Program

Is random testing being done 1 2 3 45

Documentation 1 2 3 4 5

4) Safety Incentives

Awareness of incentive program 1 2 3 45

Incentive program effectiveness 1 2 3 45

5) Incident investigation/ Case Management

Case follow-up procedures 1 2 3 45

OSHA Forms posted 1 2 3 45

6) Lockout/Tagouts

Consistent and proper use 1 2 3 45

One lock per person 1 2 3 45

7) Permit Required Confined Space

Atmospheric Testing 1 2 3 45

Permit 1 2 3 4 5

Ventilation 1 2 3 45

Low Volt 1 2 3 4 5

8) Fall Protection

Harnesses & lanyards 1 2 3 45

Ladders in good condition & tied off 1 2 3 45

Scaffolds built to OSHA specifications 1 2 3 5

9) Fire Protection/Hot Work

Hot work permit/proper use 1 2 3 5

Proper storage of flammable material 12 3 4 5

Gas bottles-properly secured, stored 1 2 3 5

10) Personal Protective Equipment

Proper eye protection 1 2 3 5

Hard hats 1 2 3 4 5

Gloves 1 2 3 4 5

Foot protection 1 2 3 4 5

Protective clothing 1 2 3 4 5

Respiratory equipment 1 2 3 5

11) Electrical

Ground fault circuit interrupters 1 2 3 5

Labels/access @ circuit breakers and disconnects 12 3 4 5

Condition of wires, cords and receptacles 1 2 3

5

Temporary wire routing-cords protected or elevated 12 3 4 5

Potable equipment tested and tagged properly 12 3 4 5

12) Machinery

Point of operation guards 1 2 3 5

Maintenance and oil leakage 1 2 3 4 5

Cleanliness 1 2 3 5

Positioning 1 2 3 5

13) Pressure Equipment

Steam equipment 1 2 3 4 5

Air receivers and compressors 1 2 3 5

14) Chemicals

MSDS available 1 2 3 4 5

Container labeling 1 2 3 4 5

Storage and use 1 2 3 4 5

cc: Safety Office, Plant Engineer, Manager of Maintenance

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Emergency shower/eyewash available 12 3 4 5

15) Tools

Power tools, wiring/hoses 1 2 3 45

Hand tools condition 1 2 3 45

Use and storage of tools 1 2 3 4 5

16) Unsafe Practices

Manlift/elevator usage 1 2 3 45

Excessive speed of vehicles 1 2 3 4 5

Improper lifting 1 2 3 4 5

Smoking in restricted areas 1 2 3 4 5

Horseplay 1 2 3 4 5

Removing machine or other guards 1 2 3 45

Work on unguarded moving machinery 12 3 4 5

17) Material Handling Equipment

Power trucks proper use 1 2 3 45

Cranes and hoists 1 2 3 4 5

Hand truck 1 2 3 45

Cables, ropes, chains and slings 1 2 3 45

18) Housekeeping

Walkways free of debris and storage 1 2 3 5

Work area free of slip/trip hazards 1 2 3 5

Stairs free of slipping/tripping 1 2 3 5

Clear access to all fire equipment 1 2 3 5

NO trash/or metal scrap scattered about 1 2 3 5

Equipment free of excessive oil, grease, grime1 2 3 5

Signs clean, visible, in good condition 1 2 3 5

Spare parts stored in proper area 1 2 3 5

Column bases free of hazard storage 1 2 3 5

Cables, ropes hoses & chains properly stored 1 2 3 5

Wash rooms & lockers 1 2 3 5

19) Miscellaneous

Safety shower/eye wash work properly 1 2 3 5

Lighting 1 2 3 4 5

cc: Safety Office, Plant Engineer, Manager of Maintenance

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