Assure Site Safety Assessment

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Evidence of observed behaviours

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• Yes

  No

  N/A

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• Yes

  No

  N/A

• Yes

  No

  N/A
Observation

• Contractor

  Select

• Other contractor

• Safe behaviour or at-risk behaviour

  Safe behaviour

  At-risk behaviour

• Category

  Select

• Risk rating

  High risk

  Medium risk

  Low risk

• Observed behaviour

• Photographs

  Media

• Repeat or embedded behaviour

• Comments

• Yes

  No

  N/A

• Comments

• Signed

  Sign