| SITE EVALUATION REPORT | |||
| Facility: | Audit Date(s): | ||
| Location: | Audit Team: | ||
| Business Unit: | Safety Contact: | ||
| Plant Manager : | Env. Contact: | ||
| Sr.No. | Criteria | Score | Remark / Observations |
| 1 | Safety Performance - LWT incident rate | 10 | |
| 2 | LWT hrs / Total hrs. worked | 10 | |
| 3 | % Compliance of CAP within the requirements (External) / (Internal) | 5 | |
| 4 | Regulatory compliance | 5 | |
| 5 | Training man days / hours per employees | 10 | |
| 6 | LOTO and its effectiveness | 10 | |
| 7 | Machine guarding and its effectiveness | 10 | |
| 8 | Job safety analysis | 10 | |
| 9 | Near Misses Reported /Timely Reporting of incidents | 10 | |
| 10 | Site 5 S Audit Score / Housekeeping | 10 | |
| 11 | Health & Environment hygiene monitoring & project tracker for the abnormal points | 10 | |
| Total Score | 100 | ||
| Score | Rating | Final Score | |
| 1 | Poor | 1 to 25 | |
| 2 | Fair | 26 to 50 | |
| 3 | Good | 51 to 75 | |
| 4 | Very Good | 75 to 100 | |