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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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