Safety and Health Audit Form

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Safety and Health Audit Form

Signages

OSH Policy

Security post

1 2 3 4

Comment

Main office, muster ground, all workplace

1 2 3 4

Comment

Road signages

Speed limit, sound horn, bridges, culverts

1 2 3 4

Comment

Sharp bends, right turns, left turns, junctions

1 2 3 4

Comment

Guard post

Wear helmets, OSH policy

1 2 3 4

Comment

STOP, security check

1 2 3 4

Comment

Compulsary signages

Wear appropriate PPE (all areas)

1 2 3 4

Comment

Classification of pesticides (chemical store)

1 2 3 4

Comment

PPE

Issuance of PPE

Records of PPE distribution

1 2 3 4

Comment

Evidence of agreement to comply with usage

1 2 3 4

Comment

Compulsory PPE for executives and staff

Executive level - helmet, safety vest, safety boots

1 2 3 4

Comment

Staff level - helmet, safety vest, safety boots

1 2 3 4

Comment

Implementation of PPE

Harvester - halmet, cotton gloves, safety boots

1 2 3 4

Comment

Sprayer - safety goggles, apron, gloves, respirators

1 2 3 4

Comment

Penalty system for non usage

Evidence of agreement between management and workers

1 2 3 4

Comment

Evidence of penalty system for non usage

1 2 3 4

Comment

Transportation safety

Proper transportation for workers

Transport trailer for workers

1 2 3 4

Comment

PPE for drivers - helmet, safety vest, safety boots

1 2 3 4

Comment

Implementation of helmets for motorcyclist

Management memo for compulsory use of helmets

1 2 3 4

Comment

Evidence of helmet use in estate

1 2 3 4

Comment

Condition of workers transportation

Maintenance records for transport trailers

1 2 3 4

Comment

Physical inspection of transport trailers

1 2 3 4

Comment

Contractors compliance to OSH

Management memo for compulsory use of PPE fro drivers

1 2 3 4

Comment

Evidence of training and compliance to estate's OSH rules

1 2 3 4

Comment

Workshop safety

Cleanliness and safe precautions

Evidence of 5S practices in daily work

1 2 3 4

Comment

Red and white poles, color coded areas

1 2 3 4

Comment

Signages

Wear appropriate PPE

1 2 3 4

Comment

OSH policy

1 2 3 4

Comment

PPE compliance

Visual inspection of PPE usage

1 2 3 4

Comment

PPE records for workshop workers

1 2 3 4

Comment

Diesel storage tank

Signages - no smoking, highly flamable

1 2 3 4

Comment

Bund wall built to hold minimum 110% capacity of diesel

1 2 3 4

Comment

Chemical store

Labelling of chemicals

All labels are in place

1 2 3 4

Comment

Temporary storage of chemicals are labelled appropriately

1 2 3 4

Comment

Local exhaust ventilation fan installed

LEV are installed in the hazardous chemical storage

1 2 3 4

Comment

Mintenance records of LEV fans

1 2 3 4

Comment

Signages

Warning signages displayed for hazardous chemicals

1 2 3 4

Comment

Compulsory signages are displayed (as in criteria signages)

1 2 3 4

Comment

OSH notice board (MSDS, SOP, OSH, policies)

Physical display of all OSH related materials

1 2 3 4

Comment

Regular updates done of OSH notice boards

1 2 3 4

Comment

Pre-mix and emergency facilities

Pre-mixing facilities

Implementation of pre-mixingg procedures for pesticides

1 2 3 4

Comment

Pre-mix trays are available for use

1 2 3 4

Comment

PPE training for sprayers

Evidence of PPE training for sprayres

1 2 3 4

Comment

Visual evidence of PPE usage among sprayres

1 2 3 4

Comment

Emergency eye wash and shower

Emercency eye wash is constructed nearby and maintained

1 2 3 4

Comment

Emergency shower is constructed nearby and maintained

1 2 3 4

Comment

Shower room and changing room for sprayers

Shower and changing room is constructed for sprayers

1 2 3 4

Comment

Evidence of usage

1 2 3 4

Comment

OSH filing

Records updated

Records of DOSH related documents updated (JKKP forms)

1 2 3 4

Comment

OSH committee meeting updated

1 2 3 4

Comment

OSH committee letter of appointment

Appointment letter for chairman is signed by Regional Head

1 2 3 4

Comment

Committee appointment letters signed by chairman

1 2 3 4

Comment

Emergency respond plan

Emergency layout plan for fire evacuation

1 2 3 4

Comment

Procedures for first aid/ medical emergencies

1 2 3 4

Comment

Training records

Evidence of training for staff and workers

1 2 3 4

Comment

Trainings are updated with evidences

1 2 3 4

Comment

Health and welfare

Linesite safety and health

General cleanliness and safety are practiced

1 2 3 4

Comment

No illegal extension and clogged drains

1 2 3 4

Comment

Rubbish collection

Documented rubbish collection available and displayed

1 2 3 4

Comment

Rubbish collection pit is available and maintained

1 2 3 4

Comment

Fogging

Annual fogging schedule available

1 2 3 4

Comment

Fogging is conducted in regular intervals

1 2 3 4

Comment

Medical facilities

Hospital Attanden available

1 2 3 4

Comment

Clinic facilities are available

1 2 3 4

Comment

Disclosure

Auditor

Sustainability Unit Personel

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Auditee

OPUN Personel

Select date

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Manager

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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.