APA Group - HSE Management Interaction Template (HSE GP:04.02:T5)

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Business

• Asset/Location

• Site

• Select date

  Date

• Person Conducting:

• Person(s) Accompanying:

HSE Conversation

• Potential topic: Current HSE initiatives on this site; Current HSE Committee projects; Personal Involvement in HSE on site

• General Comments

HSE Observation (site walk through)

• Potential focus:Housekeeping - entry, workshop, yard; visible safety cues: eg Noticeboards, high visibility clothing, electrical switchboards, guarding, signage

• General comments:

• Items to follow-up

Items

• Item

• Select date

  Date

• Responsible Person

• Item for follow up agreed on site:

  Yes

  No

• Person conducting:

• Person accompanying:

Administration / HSE use only

• Date received:

• Entered into Workwise:

• By: