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HSE Internal Audit Form

The Internal HSE Audit Form is designed to assess compliance with health, safety, and environmental standards among workers. It includes sections for evaluating toolbox meetings, documentation, equipment inspections, personal protective equipment, and emergency procedures. Any identified issues must be addressed, and corrective actions documented for follow-up.

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Nicholas Boudreau
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58 views3 pages

HSE Internal Audit Form

The Internal HSE Audit Form is designed to assess compliance with health, safety, and environmental standards among workers. It includes sections for evaluating toolbox meetings, documentation, equipment inspections, personal protective equipment, and emergency procedures. Any identified issues must be addressed, and corrective actions documented for follow-up.

Uploaded by

Nicholas Boudreau
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Internal HSE Audit Form

Internal HSE Audit form


Worker Name & ID (Being List Names of workers in
Worker Position Direct Supervisor
Audited) Crew

HSE Coordinator
Date / Time Location and Section
Performing Audit

Weather Condition

Stop work- Unsatisfactory – Satisfactory –


Color Exceeds
Requirement not immediate action no action
Code Expectations
met required required

1.0 Daily ToolBox N/A


1.1 Has employee taken part in Toolbox meeting and signed on 
(Employee can verbally describe topics / safety points)
1.2 Toolbox is properly filled out 
1.3 Task being performed is noted 
1.4 Task plan is descriptive and understandable 
1.5 Safety topic is noted 
2.0 Documentation N/A
2.1 Employee has completed FLHA
2.2 Does employee hold proper competencies
2.3 Safe work permit (if required)
2.4 Ground disturbance permit (if required)
2.5 Hot work permit (if required)
2.6 Worker has appropriate ground disturbance certificate
3.0 FLHA Inspection N/A
3.1 FLHA accurately captures all workers involved in the task, location,
date/time, all controls put into place?
3.2 Emergency contact details included.
3.3 Team lead / foreman signed off
3.4 Workers can verbally describe task at hand, hazards associated, and
control measures?
4.0 Equipment Inspection N/A
4.1 Equipment inspection has been filled out
Equipment is in good working order (HSE Coordinator to verify operator
4.2
inspection)
4.3 Machine housekeeping is satisfactory.
5.0 Personal Protection Equipment N/A
5.1
Worker has all appropriate PPE required for site and task being performed.
5.2 PPE is in good condition.
5.3 Boots are appropriate Height (6”)
5.4 All PPE CSA approved
5.5 Worker has specialized PPE for task (if required)
Internal HSE Audit Form
6.0 Scope of Work N/A
6.1 Worker fully understands the task they are performing?
6.2 Worker has appropriate training for the task being performed (HSE to ask)
6.3 Worker is Fit for Duty.
6.4 If worker is new, someone is designated as their mentor.
6.5 Worker understands the meaning of fit for duty
7.0 Tools N/A
7.1 Tools being use are in good working condition
7.2 Worker has been trained for the tools being used
8.0 Working at Height Platforms (If required) N/A
8.1 Worker has Mobile Elevating Work Platform Certification
8.2 Harness and fall arrest lanyard in good working condition and not expired
8.3 Worker is hooked up properly
9.0 Lifting Operations (If required) N/A
9.1 Lift plan is in place
9.2 Everyone involved in the lift has signed onto the FLHA
9.3 All appropriate parties have been notified
9.4 Safe work permit has been issued
9.5 Lift calculation is completed (only for crane lifts)
9.6 Lift is >75% capacity
10.0 Incident reporting and Hazard ID reporting N/A
10.1 Worker can describe the steps in the event of an incident
10.2 Worker understands all incidents / near misses / injuries must be reported
10.3 Worker understands to report any unsafe work / condition
10.4 Worker Understands Hazard ID reporting (Near miss/ Pos/Neg
Observation)
11.0 First Aid / Fire extinguisher / Muster location N/A
11.1 First Aid locations known
11.2 Fire extinguisher locations are known, up to date, and signed off.
11.3 Muster location known
12.0 Emergency Procedure N/A
12.1 Worker can verbally describe what to do in the event of a muster
12.2 Worker knows all exit points incase muster points aren’t available
13.0 Environmental Reporting N/A
13.1 Worker understands to report all spills and leaks
13.2 Spill Kit locations are known
13.3 Worker understands how to use a spill kit

A copy is to be kept by the Direct Supervisor. Any outstanding issues must be addressed and
updated form sent to HSE Team within the time frame agreed upon.
Internal HSE Audit Form
Section Issue identified Corrective Action(s) Action Agreed Date Completed Action
Number Owner(s) for (Date) owner
Completion Initial

OTHER COMMENTS

HSE Name:________________________ Employee Name & ID:____________________ Manager Name:_______________________

HSE Signature:_____________________ Employee Signature:______________________ Manager Signature:____________________

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