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FREQUENCY DATE
WEEKLY / MONTHLY / QUARTERLY (Select as applicable)
Location
Leadership & Commitment Status (✓/✗) Remarks
Top management demonstrates visible commitment to HSE through
site presence.
HSE policy is signed by top management and prominently displayed.
HSE roles and responsibilities are clearly defined and
communicated.
HSE performance discussed regularly at leadership meetings.
Resources (budget, manpower, time) allocated for HSE initiatives.
Safety leadership programs or behavior-based safety initiatives are
active.
Management engages with frontline workers through safety
dialogues.
Internal communications include regular safety performance
updates.
Recognition or reward systems in place for safe behaviors.
Organizational decisions consider safety impacts.
HSE Policy & Legal Compliance Status (✓/✗) Remarks
Current HSE policy reflects scope and activities of the organization.
Legal and regulatory requirements register is documented and
updated.
Company tracks updates to laws relevant to its operations.
Evidence of compliance audits or assessments is available.
Non-compliances or deviations are documented with corrective
actions.
Site activities align with policy objectives and applicable legislation.
Permits (e.g., environmental, pressure vessels) are valid and
accessible.
Staff are aware of legal obligations relevant to their work.
External audits conducted and reports available.
Evidence of compliance with country-specific HSE laws (e.g.,
OSHA/UK HSE/UAE Code).
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Risk Assessment & Control Measures Status (✓/✗) Remarks
Job-specific risk assessments are conducted and documented.
Risk assessments are reviewed periodically or after
changes/incidents.
Risk ranking methodology follows a defined matrix.
Risk control measures follow the hierarchy of controls.
Employees involved in risk assessment process.
PTW (Permit to Work) incorporates task-specific risk controls.
Residual risk documented and accepted by management where
applicable.
Records of toolbox talks linked to key task risks.
Site-wide hazards (e.g., traffic, fire, fall) assessed separately.
Risk registers are maintained for ongoing or long-term activities.
Emergency Preparedness & Response Status (✓/✗) Remarks
Emergency preparedness plan (EPP) is site-specific and approved.
Emergency drills (fire, spill, confined space) conducted and logged.
Drill evaluation reports include observations and corrective actions.
Assembly points clearly marked and unobstructed.
Emergency contact numbers are posted and updated.
Firefighting equipment is accessible, tagged, and within inspection
date.
Spill kits, AEDs, stretchers, etc., are in place and functional.
Emergency alarms and public address systems are operational.
Training records of emergency response teams available.
Records of lessons learned and response time improvements
maintained.
Operational Control Status (✓/✗) Remarks
Standard Operating Procedures (SOPs) available and understood by
staff.
Permit-to-Work system is consistently implemented.
Isolation procedures (LOTO) followed for equipment maintenance.
Confined space entries have documented hazard controls.
Scaffolds, ladders, and work-at-height platforms inspected regularly.
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Lifting operations use approved rigging gear and trained personnel.
Contractors follow the same HSE standards and are monitored.
Hazardous areas have restricted access and are clearly signed.
Flammable or explosive materials stored as per regulation.
Equipment and tools tagged, maintained, and operated safely.
Training, Awareness & Competence Status (✓/✗) Remarks
New hires receive documented HSE induction.
Refresher training completed as per schedule.
Training matrix maps job roles to required competencies.
Training records maintained and include sign-in sheets & certificates.
Critical task training (e.g., hot work, confined space) provided.
Emergency response training conducted for key personnel.
Contractors and visitors are trained before site access.
Supervisors trained in hazard identification and risk management.
Toolbox talks held regularly and topics relevant to tasks.
Competency assessment process in place for high-risk activities.
New hires receive documented HSE induction.
Incident Investigation & Reporting Status (✓/✗) Remarks
All incidents and near-misses reported promptly using a standard
form.
Incident investigation team includes trained personnel.
Root Cause Analysis (RCA) conducted for major incidents.
Corrective and preventive actions tracked to closure.
Trends of incidents analyzed monthly (e.g., slips, falls, strains).
Workers know how to report incidents confidentially.
Incident reports are reviewed during safety meetings.
External reporting obligations (e.g., OSHA, local HSE) met.
Lessons learned from incidents shared site-wide.
Delayed or incomplete incident reporting investigated.
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Monitoring & Inspection Status (✓/✗) Remarks
Routine workplace safety inspections conducted and recorded.
Pre-use checks for tools, machinery, and vehicles performed.
Statutory inspections (e.g., lifting, pressure vessels) up to date.
Findings from inspections categorized by severity.
Action tracking system in place for inspection findings.
Leadership participates in scheduled safety walkthroughs.
Non-conformities and unsafe conditions corrected timely.
Use of checklists during inspections is mandatory.
Equipment tagged out if found defective.
Health & Welfare Facilities Status (✓/✗) Remarks
Toilets are clean, supplied, and gender-separated where applicable.
Handwashing facilities and sanitizers available at entry/exit points.
First aid room clean, ventilated, and operational.
Rest areas sheltered, with drinking water and seating.
PPE changing rooms and lockers maintained.
Ventilation and air quality in welfare areas acceptable.
Heat stress mitigation in place (e.g., shaded areas, electrolyte packs).
Pest control records maintained and visible.
Cleanliness schedule displayed and followed.
Health surveillance provided for exposed workers (noise, chemicals).
Document Control & Record Keeping Status (✓/✗) Remarks
HSE documents are version-controlled (e.g., Rev 1, Rev 2).
Master list of controlled documents maintained.
Obsolete documents removed from point of use.
Records (training, permits, incidents) retained as per policy.
Access to records restricted to authorized personnel.
File naming and archiving consistent across departments.
HSE documentation audit trail available.
Confidential records (medical, investigation) handled securely.
Checklists and inspection forms standardized.
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Environmental Compliance (if applicable) Status (✓/✗) Remarks
Waste is segregated (e.g., hazardous, general, recyclable).
Emissions (air, noise) monitored and within regulatory limits.
Environmental permits are valid and displayed.
Secondary containment used for fuel and chemical storage.
Spill response plans and kits maintained.
Drains protected from chemical runoff and blocked if needed.
Records of waste manifests and disposal receipts available.
Groundwater protection measures (e.g., liners, bunds) in place.
Site not exceeding environmental license thresholds.
No signs of uncontrolled leaks, stains, or illegal dumping.
Management Review & Continuous Improvement Status (✓/✗) Remarks
Internal and external audit findings reviewed in leadership meetings.
Safety KPIs tracked, trended, and discussed (e.g., TRIR, LTI).
Annual HSE objectives are SMART and reviewed.
Non-conformity closure rates reported to top management.
Worker suggestions and innovations documented.
Follow-up on past audits shows improvement.
Changes to HSE legislation considered in reviews.
Strategic plans include HSE improvement roadmap.
Review minutes signed by management and action owners.
HSE budget allocation tracked and justified
Inspected By;
Name: .............................................. Designation: .....................................
Signature: .....................................
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