Blank Audit Template
Blank Audit Template
Blank Audit Template
AUDIT CHECKLIST
SITE NAME:
DATE OF AUDIT:
DATE:
12 October 2012
Page 1 of 9
ITEM
NO.
TASK
1.0
DOCUMENTATION
1.1
Health and Safety Forms:Are copies of the forms detailed below available for issue
1.2
a)
b)
Accident Record
c)
d)
e)
Site Inspection
f)
g)
h)
i)
j)
Risk Assessments
k)
COSHH Assessments
Y/N/NA
CORRECTIVE/PREVENTIVE ACTION
TARGET DATE/
RESPONSIBILITY
COMPLETION
DATE
Health and Safety Manual:a) Do all employees have access to a copy of the Health and
Safety Manual
b) If not, do they have a contact to look up queries for them
c) Are records maintained
1.3
Accident Reporting
a) Are there accident records in place for the site
b) Are current procedures in place for reporting incidents
2.0
2.1
TRAINING
Induction Training
12 October 2012
Page 2 of 9
ITEM
NO.
TASK
Y/N/NA
CORRECTIVE/PREVENTIVE ACTION
TARGET DATE/
RESPONSIBILITY
COMPLETION
DATE
3.0
3.1
a)
b)
c)
d)
e)
4.0
OFFICE HOUSEKEEPING
4.1
a)
b)
5.0
5.1
RISK ASSESSMENT
Safe Access and Egress;
a) Is there safe access and egress routes to the premises.
12 October 2012
Page 3 of 9
ITEM
NO.
5.3
TASK
Y/N/NA
CORRECTIVE/PREVENTIVE ACTION
TARGET DATE/
RESPONSIBILITY
COMPLETION
DATE
5.3
Noise Assessments:a)
5.4
b)
c)
b)
c)
6.0
OFFICE VENTILATION/TEMPERATURE
6.1
1.
7.0
WELFARE
7.1
a)
b)
c)
d)
8.0
FIRST AID
8.1
a)
b)
c)
12 October 2012
Page 4 of 9
ITEM
NO.
TASK
d)
e)
f)
g)
CONTROL OF CONTRACTORS
a)
b)
d.
10.3
COMPLETION
DATE
FIRE PRECAUTIONS
Fire Certificate
a)
b)
c)
Administration:a)
b)
c)
d)
e)
f)
10.4
TARGET DATE/
RESPONSIBILITY
9.1
10.2
CORRECTIVE/PREVENTIVE ACTION
If First Aiders are required, have they received the full 4 day
First Aid Training and do they hold current Certificates.
Are adequate First Aid Boxes and Eye Wash Stations provided.
9.0
10.0
10.1
Y/N/NA
Fire Extinguishers:-
12 October 2012
Page 5 of 9
ITEM
NO.
TASK
a)
b)
c)
10.5
10.6
10.7
11.0
11.1.
Y/N/NA
CORRECTIVE/PREVENTIVE ACTION
TARGET DATE/
RESPONSIBILITY
COMPLETION
DATE
b)
c)
d)
e)
Can the Fire Alarm be heard in all locations (e.g. plant rooms,
offices etc).
Emergency Lighting:a)
b)
Fire Signage
a)
Has adequate signage been provided e.g. Fire Exit Routes etc.
b)
c)
WORK EQUIPMENT
Access Equipment:a) Is a register in place
b) Does the equipment display the inspection period.
c) Confirm the responsible person for checking Access
Equipment.
11.2
12 October 2012
Page 6 of 9
ITEM
NO.
TASK
Y/N/NA
CORRECTIVE/PREVENTIVE ACTION
TARGET DATE/
RESPONSIBILITY
COMPLETION
DATE
Hot work
General
Confined space
Non-electrical
12.0
12.1
a)
b)
Has a full survey been carried out and are all relevant COSHH,
Assessments and Manufacturers Product Data Sheets
available (site specific).
Confirm arrangements for issuing COSHH assessments to
sites.
c)
d)
13.0
VEHICLES
13.1.
a)
b)
c)
14.0
EMPLOYMENT OF SUB-CONTRACTORS
14.1
a) Have all sub-contractors been issued with the Standard Rules for
Sub-contractors on Safety, Health and the Environment
b) Have questionnaires been completed for each sub-contractor
12 October 2012
Page 7 of 9
ITEM
NO.
TASK
Y/N/NA
CORRECTIVE/PREVENTIVE ACTION
TARGET DATE/
RESPONSIBILITY
COMPLETION
DATE
12 October 2012
Page 8 of 9
ADMIN DOCUMENTATION
2.0
TRAINING
3.0
4.0
OFFICE HOUSEKEEPING
5.0
RISK ASSESSMENT
6.0
7.0
WELFARE
8.0
FIRST AID
9.0
CONTROL OF CONTRACTORS
10.0
FIRE PRECAUTIONS
11.0
WORK EQUIPMENT
12.0
13.0
VEHICLES
14.0
EMPLOYMENT OF CONTRACTORS
RATING NO.1
RATING NO.2
RATING NO.3
RATING NO.4
LEGEND:
1=ABOVE AVERAGE
2=SATISFACTORY PERFORMANCE/STANDARD
3=BELOW ACCEPTABLE PERFORMANCE/STANDARD
4=UNACCEPTABLE PERFORMANCE/STANDARD
12 October 2012
Page 9 of 9