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Lumiform Mobile audits & inspections
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Safety and Health Audit Form

A standard health and safety audit form is recommended for all types of businesses, such as retail stores and restaurants. Every employer is required to conduct regular on-site health and safety controls and processes. A monthly audit will help you keep on top of your health and safety processes.

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Signages
OSH Policy
Security post
Comment
Main office, muster ground, all workplace
Comment
Road signages
Speed limit, sound horn, bridges, culverts
Comment
Sharp bends, right turns, left turns, junctions
Comment
Guard post
Wear helmets, OSH policy
Comment
STOP, security check
Comment
Compulsary signages
Wear appropriate PPE (all areas)
Comment
Classification of pesticides (chemical store)
Comment
PPE
Issuance of PPE
Records of PPE distribution
Comment
Evidence of agreement to comply with usage
Comment
Compulsory PPE for executives and staff
Executive level - helmet, safety vest, safety boots
Comment
Staff level - helmet, safety vest, safety boots
Comment
Implementation of PPE
Harvester - halmet, cotton gloves, safety boots
Comment
Sprayer - safety goggles, apron, gloves, respirators
Comment
Penalty system for non usage
Evidence of agreement between management and workers
Comment
Evidence of penalty system for non usage
Comment
Transportation safety
Proper transportation for workers
Transport trailer for workers
Comment
PPE for drivers - helmet, safety vest, safety boots
Comment
Implementation of helmets for motorcyclist
Management memo for compulsory use of helmets
Comment
Evidence of helmet use in estate
Comment
Condition of workers transportation
Maintenance records for transport trailers
Comment
Physical inspection of transport trailers
Comment
Contractors compliance to OSH
Management memo for compulsory use of PPE fro drivers
Comment
Evidence of training and compliance to estate's OSH rules
Comment
Workshop safety
Cleanliness and safe precautions
Evidence of 5S practices in daily work
Comment
Red and white poles, color coded areas
Comment
Signages
Wear appropriate PPE
Comment
OSH policy
Comment
PPE compliance
Visual inspection of PPE usage
Comment
PPE records for workshop workers
Comment
Diesel storage tank
Signages - no smoking, highly flamable
Comment
Bund wall built to hold minimum 110% capacity of diesel
Comment
Chemical store
Labelling of chemicals
All labels are in place
Comment
Temporary storage of chemicals are labelled appropriately
Comment
Local exhaust ventilation fan installed
LEV are installed in the hazardous chemical storage
Comment
Mintenance records of LEV fans
Comment
Signages
Warning signages displayed for hazardous chemicals
Comment
Compulsory signages are displayed (as in criteria signages)
Comment
OSH notice board (MSDS, SOP, OSH, policies)
Physical display of all OSH related materials
Comment
Regular updates done of OSH notice boards
Comment
Pre-mix and emergency facilities
Pre-mixing facilities
Implementation of pre-mixingg procedures for pesticides
Comment
Pre-mix trays are available for use
Comment
PPE training for sprayers
Evidence of PPE training for sprayres
Comment
Visual evidence of PPE usage among sprayres
Comment
Emergency eye wash and shower
Emercency eye wash is constructed nearby and maintained
Comment
Emergency shower is constructed nearby and maintained
Comment
Shower room and changing room for sprayers
Shower and changing room is constructed for sprayers
Comment
Evidence of usage
Comment
OSH filing
Records updated
Records of DOSH related documents updated (JKKP forms)
Comment
OSH committee meeting updated
Comment
OSH committee letter of appointment
Appointment letter for chairman is signed by Regional Head
Comment
Committee appointment letters signed by chairman
Comment
Emergency respond plan
Emergency layout plan for fire evacuation
Comment
Procedures for first aid/ medical emergencies
Comment
Training records
Evidence of training for staff and workers
Comment
Trainings are updated with evidences
Comment
Health and welfare
Linesite safety and health
General cleanliness and safety are practiced
Comment
No illegal extension and clogged drains
Comment
Rubbish collection
Documented rubbish collection available and displayed
Comment
Rubbish collection pit is available and maintained
Comment
Fogging
Annual fogging schedule available
Comment
Fogging is conducted in regular intervals
Comment
Medical facilities
Hospital Attanden available
Comment
Clinic facilities are available
Comment
Disclosure
Auditor
Sustainability Unit Personel
Select date
Auditee
OPUN Personel
Select date
Manager
Select date
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Please note that this checklist template is a hypothetical appuses-hero example and provides only standard information. The template does not aim to replace, among other things, workplace, health and safety advice, medical advice, diagnosis or treatment, or any other applicable law. You should seek your professional advice to determine whether the use of such a checklist is appropriate in your workplace or jurisdiction.

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