PSM_-_Contractor_Annual_Audit_Form.pdf

PDF 143 KB Posted

Attached to
Unit 5 Spring 2025 Outage Contractor Services
Solicitation number
2025-RFP-002
Issued by
Sangamon County, Florida

About this file

The document is a PSM-Contractor Annual Audit Form issued by the City of Lakeland's Risk Management and Purchasing department. The form is designed to conduct an annual audit of contractors to assess their safety performance and compliance across multiple criteria, including EMR (Experience Modification Rate), drug and alcohol policies, written safety plans, safety compliance programs, safety records, employee training records, and overall onsite safety performance.

The audit form provides a structured evaluation mechanism to determine a contractor's continued eligibility for inclusion on the PSM-Approved Contractors List. By systematically reviewing key safety metrics and documentation, the City of Lakeland can ensure that contractors maintain high safety standards and meet the municipality's risk management requirements. The form allows auditors to comprehensively document their findings and make a final determination on whether a contractor remains approved for future work, with checkboxes to indicate approval or non-approval status.

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Text version

City of Lakeland, Risk Management and Purchasing

PSM- Contractor Annual Audit Form

Contractor: _____________________________________ Date: _______________

Project: _______________________________________________________________

Location: ______________________________________________________________

Audit Item Audit Result Comments

EMR (<1.0)

Drug and Alcohol Policy Written Safety Plan Safety Compliance Program

Safety Records Employee Training Records

Acceptable Safety Performance Onsite

Contractor, ___________________________________, ☐ is ☐ is not approved for continued inclusion on the PSM-Approved Contractors List.

Audit performed by: ______________________, Title: __________________________

Auditors signature: ______________________________________ Date: ___________

File details come from the government source that posted it. Updated .