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OCCUPATIONAL HEALTH AND SAFETY AUDIT/ASSESSMENT

Company/Institution: Facility: Audit/Assessment date:
Building/Facility covered on this on this audit/assessment:
Building Storey:
Address:
Note:

Legends:

OHS: Occupational Health & Safety S: Satisfactory US: Unsatisfactory N/A: Not Applicable

Documents
A. OHS Documents S US N/A Comments Corrective Action Correction Completed
1 OHS Policy:
2 OHS Manual:
3 Safety Organization in case of emergency
4 Other relevant documents

B. Company/Institution Data S US N/A Comments Corrective Action Correction Completed

1 Area (in square meter):
First Floor:
Second Floor:
Third Floor:
Parking Area:
Building/Office lay out:

2 Total employee/personnel: S US N/A Comments Corrective Action Correction Completed

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C. Emergency Risk Control S US N/A Comments Corrective Action Correction Completed

Assembly area for emergency evacuations
1
is clearly marked
Is the Emergency Evacuation Route &
2
Action Plan posted?
3 Are exit signs illuminated and visible
Are corridors and exits free from
4
obstruction and locked
5 Stair way are not being used for storage
All emergencies that could require
evacuation of the working area have been
6
identified and contingency plans
developed
Signals/instructions that will trigger an
7 evacuation have been established and
communicated
Those responsible for activating
8 alarms/warning signals have been
nominated and informed
Emergency procedures are clearly
9 displayed in the workplace at appropriate
locations
Emergency procedures are included in
10 induction training for all new employees
and volunteers
Evacuation route has been identified and
11 needs of people with disabilities
considered
Assembly points have been identified and
12 communicated to all employees and
volunteers
Procedures are in place to ensure everyone
13 (including clients, visitors and contractors)
are accounted for
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Re-entry procedures have been

14 established and persons nominated to
manage this following the “all clear”
Home visit and emergency call-out
15
procedures in place and followed
Do building conform to standards or
16 regulation with respect to use for occupancy,
services and plumbing facility
17 Are smoke detectors installed
18 Are there fire hydrant in the building
19 Are fire hydrant regularly inspected

D. Fall and Trip Hazards S US N/A Comments Corrective Action Correction Completed
1 Is the floor surface level safe and undamaged
2 The floor condition:
a. Non-slip mats are in entryways if needed
b. Are carpeted areas clean, carpets secured
to floor and free of worn or frayed seams
c. Is any equipment or supplies protruding
into walkways
d. Are there cords or cables causing a trip
hazard
e. Are permanent use cords covered by
runners when crossing walkways
Is a step stool or ladder available to minimize
3
the use of chairs for reaching high objects

E. Electrical Hazards S US N/A Comments Corrective Action Correction Completed

Are switchboard and electrical equipment in
1
good and safe condition
Are electrical installations and equipment
2
regularly inspected and tagged
Electrical leads free from kinks, frays, loose
3
or expose wire or lead
4 Electrical cords secured behind skirting cover
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or pinned to skirting boards (i.e. not dangling

or trailing on ground)
5 Are Electrical cords not exposed to moisture
Main and isolating switches clearly signed
6
and accessible
Plugs, sockets and switches in safe places
7 and free from obvious defects (loose,
broken, overheating

F. Mechanical Hazards S US N/A Comments Corrective Action Correction Completed

Are there any other exposed mechanical
1 parts that might be sharp or otherwise
hazardous (screws, bolts, edges, etc.)?
Are there safeguards at the point of
2
operation?
Are rotating parts of the office equipment
3
safeguarded

G. Emergency Equipment/Extinguisher S US N/A Comments Corrective Action Correction Completed

Is all fire control equipment regularly tested Ref to Manpower Regulation No.
1
and certified Per-04/Men/1980
Is fire control equipment appropriate and
2
comply to regulations
Is quantity of fire control equipment comply
3
to the regulations
Are fire extinguishers easily accessible,
4
checked monthly, and operational?
Are fire extinguishers mounted so that the
5 travel distance from employees to any
extinguisher is 75 feet or less?
H. Fire Exit and Procedure S US N/A Comments Corrective Action Correction Completed
Smoke detectors and alarms appropriately
1
located and in working order
2 Accessible fire exits
3 Uncluttered fire exits and stairwells
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Regular fire drills held and staff

4
participation documented
5 Fire exits unlocked during working hours
6 Staff trained in the use of fire extinguisher
Fire wardens clearly identified (eg hard
7
hat) and names displayed in workplace
I. Air Handling System S US N/A Comments Corrective Action Correction Completed
Is the system free of sources contaminations
1
(asbestos, microorganism, dust, fume)?
2 Is humidity can be arranged or control

J. First Aid Facility S US N/A Comments Corrective Action Correction Completed

Are first aid kit or P3K kit boxes comply to Ref to Manpower Regulation
1
the requirements No.Per.15/MEN/VIII/2008
2 Has safety officers been trained
3 Name of trained first aider clearly displayed
3 Are P3K kits box placed properly
4 Easy to access
5 Are all first aid kit clearly labelled

K. Ventilation S US N/A Comments Corrective Action Correction Completed

Is the area free from any build up of noxious
1
fumes from exhaust gases
Are there exhaust ventilation system in use,
2
and are they functioning correctly
Exhaust fan above photocopier and
3
operational
L. Noise S US N/A Comments Corrective Action Correction Completed
1 Noise source/equipment properly installed
Noise source/equipment properly
2
maintained
Main and isolating switches clearly signed
3
and accessible
4 Noise reduction mechanisms installed in
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high noise areas eg photocopier room

M. Ergonomics S US N/A Comments Corrective Action Correction Completed
All office furniture’s/equipment is designed
1
correctly
Are employee workstation being used
2
correctly and avoiding stretching
Employees are properly position at their desk
3
and maintain good neutral posture
N. Sanitation /Health S US N/A Comments Corrective Action Correction Completed
1 Is it promoted at the workplace a culture of
regularly cleaning, with adequate detergent
and/or disinfectant)?
a. Surfaces of desks, telephones and
keyboards?
b. Common areas such as toilettes, rest
rooms, cafeteria, meeting rooms, etc?
2 Are sanitation bin properly place and
covered
3 Are washrooms and food preparation areas
clean?
O. Kitchen/Pantry
Are the kitchen counters kept clean and
1
clear?
2 Are smoke detectors installed
Is housekeeping being adequately
3
maintained?
Is there a weekly or monthly fridge clean
4
out and disinfectant schedule
Are cleaning equipment chemicals stored
5
appropriately and away from food
Do you have a weekly or monthly fridge
6
clean out and disinfectant schedule?
Are there appropriate bins for place in
pantry/kitchen
7 Is there exhaust installed and in good
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condition
Slip resistant mats are in front of each piece
8 of equipment with special attention to the
dishwashing area?
9 Are gas appliances functioning properly
Precautions taken to prevent burns when
10
working with steam pots?
Are cleaning equipment chemicals labelled
11
appropriately?
P. Hazardous Products/Substances S US N/A Comments Corrective Action Correction Completed
1 All containers properly labeled
Are MSDS available for office and
2
housekeeping chemicals?
3 All containers properly stored
4 Others
Q. Material Storage S US N/A Comments Corrective Action Correction Completed
1 Are material neatly and safely piled
Are there stepladders or stools to get to
2
materials on higher shelves

R. Building External and Boundary

S US N/A Comments Corrective Action Correction Completed
Perimeter
a. Vehicle Parking
1 Adequate lighting in all car park areas
2 Vandal resistant security lights in car parks
Entrance and exits to car park are clearly
3
marked
Traffic and speed restriction signs are
4
clearly visible and free from obstruction
5 No parking areas clearly marked
Required direction of traffic is clearly
6 defined and clearly indicated by signs
and/or painted roadways
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b. Building External and Boundary Perimeter

Entrance and exits to building are clearly
1
marked
Pathways free from raised curbs and
2
projection
Steps and changes of level are clearly
3
defined and indicated
4 Adequate lighting of pathways
Waste bins provided and are regularly
5
emptied
6 Windows secure and unbroken
Signs clearly displayed to indicate security
7
arrangements in place
Surface of pathways and walkways is even
8 and free of pot-holes and cracks or other
tripping hazards
S. Security S US N/A Comments Corrective Action Correction Completed
Are emergency (evacuation, bomb thread,
1
fire, hostile person) procedure in place
Arrangements made to ensure employees
2 do not need to access outside storage
areas at nigh
Security procedures for all premises
3
developed and followed day and night
Access at night restricted to as few
4
entrances as possible
5 Data record are properly maintained

References:

1. Indonesia Act No.1 Year 1970 Concerning Work Safety

2. Indonesia Act No.13 Year 2003 Concerning Workforce
3. Regulations of Manpower Ministry of Indonesia
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Additional Comments: …………………………………………………………………………………………..

Assessed/Audited by: Approved by:

Name: ………………………………….. Name: ………………………………………………………