K-ELECTRIC LIMITED

POWER GENERATION STATION

SAFETY AUDIT FORM
Location : Date of Audit
Time Begun : a.m. / p.m. Time Ended : a.m. / p.m. No. of people

CATEGORY A CATEGORY B CATEGORY C CATEGORY D

Reaction of People Position Personal Tools &
of People Protective Equipment
Equipment

• Adjusting protective • Eyes and face • Right for the job

equipment • Ears • Used correctly
• Changing position • Head • In safe condition
• Rearranging the job. • Hands and arms • Works area design
• Stopping the job • Feets and legs • Tools grips
• Attaching grounds/ • Striking agianst • Respiratory system • Vibration
lockouts • Struck by • Appropriate clothing • Temperature
• Caught between • Lighting
• Falling • Noise
• Contacting temperature
extremes.
• Contacting electric
current
• Inhaling hazardous
substance
• Swallowing a
hazardous substance.
• Posture/ Lifting/ Twisting
• Type/ number of
motions
• Load handling

Commendable safe action observed

Audit Team :
Crew :
CC :
 / /

people observed:

CATEGORY E
Procedures &
Housekeeping

• Procedure
inadequate for job
• Procedure not
known /understood
• Procedure not
followed
• Appropriate working
permits
• Housekeeping
Page 1 of 2
 K-ELECTRIC LIMITED
POWER GENERATION STATION
OBSERVATION
WORST POTENTIAL
DESCRIPTION OF THE INJURY
UNSAFE ACT
WORK/LOC'N/EVENT UNSAFE/HIGH RISK MINOR/SERIOUS/FATA
CATEGORY
ACT OR CONDITION
Example : Receiving Two unsheathed knives on Procedure M
cluttered bench

Example : Repair shop Machinist grinding without eye PPE Ser

protection

Example : Polymer B Operating valve on pipe, Tools & Equipment

unsecured @ 10'

ITEMS FOR FOLLOW-UP

CATEGORY ACTION TAKEN TO RECTIFY

 POTENTIAL
NJURY
ERIOUS/FATAL

Minor

Serious

Fatal

DATE
Page 2 of 2