Process Safety Management Audit Checklist Form
Complete the Process Safety Management Audit Checklist to assess compliance and identify opportunities for improvement.
Audit Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Auditor Name
*
First Name
Last Name
Facility/Process Audited
*
Process Safety Information is up to date and accessible
*
Compliant
Non-Compliant
Not Applicable
Operating Procedures are current and followed
*
Compliant
Non-Compliant
Not Applicable
Employee Training is documented and up to date
*
Compliant
Non-Compliant
Not Applicable
Management of Change (MOC) process is implemented
*
Compliant
Non-Compliant
Not Applicable
Overall Process Safety Management system effectiveness
*
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
Additional Findings or Recommendations
Checklist Completion Status
*
Complete
Incomplete
Submit Checklist
Should be Empty: