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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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Safety and Health Audit Form

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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