Observation List

  • Instructions

    1. Determine the condition of each item below if they are either "Safe", "At-Risk" or "N/A"
    2. Add photos and notes by clicking on the paperclip icon
    3. To add corrective actions, click on the paperclip icon then "Add Action", provide a description, assign to a member, set priority and due date
    4. Complete audit by providing digital signature
    5. Share your report by exporting as PDF, Word, Excel or Web Link

1. PPE

  • IMPORTANT:

    • Inform the employee that you are conducting an observation
    • Record your observations, focus on Safe Behaviors
    • Provide feedback

  • 1.1. Head (hard hat, bump cap)

  • 1.2. Eyes and Face (glasses with side shield, goggles)

  • 1.3. Hearing (ear plugs)

  • 1.4. Hands (gloves)

  • 1.5. Fall protection (harness with lanyard)

  • 1.6. Shoes (steel or composite toe)

  • 1.7. PPE in good condition

  • 1.8 Are there other items that were not included on this category?

  • Others

    Click "Add Item" to enlist additional item on the category list

  • Item
  • Description

  • • Condition

2. Body Position

  • 2.1. Position proper for the task

  • 2.2. Heavy lifting (proper position, 2-person lift)

  • 2.3. Risk of slips/falls

  • 2.4 Are there other items that were not included on this category?

  • Others

    Click "Add Item" to enlist additional item on the category list

  • Item
  • Description

  • • Condition

3. Work Environment

  • 3.1. 5S/Housekeeping

  • 3.2. Walking/working surfaces

  • 3.3. Using handrails (if applicable)

  • 3.4 Are there other items that were not included on this category?

  • Others

    Click "Add Item" to enlist additional item on the category list

  • Item
  • Description

  • • Condition

4. Procedures

  • 4.1. Familiar with emergency procedures

  • 4.2. LOTO being used

  • 4.3. Driving at safe speed

  • 4.4. Permit to work

  • 4.5. Able to locate SDS

  • 4.6 Are there other items that were not included on this category?

  • Others

    Click "Add Item" to enlist additional item on the category list

  • Item
  • Description

  • • Condition

5. Tools and Equipment

  • 5.1. Safety equipment in good condition

  • 5.2. Tools and equipment are stored correctly

6. Sustainability

  • 6.1. Using the correct recycling containers

  • 6.2. Equipment off when not in use (conveyors, air)

  • 6.3. Environmental harm

  • 6.4 Are there other items that were not included on this category?

  • Others

    Click "Add Item" to enlist additional item on the category list

  • Item
  • Description

  • • Condition

Additional Comments & Feedback

  • Provide additional comments & feedback relevant to the observation

The Golden Rules

  • ill.jpg

Completion

  • Observer's Name and Signature

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. Any ratings or scores displayed in our Public Library have not been verified by SafetyCulture for accuracy. Users of our platform may provide a rating or score that is incorrect or misleading. You should independently determine whether the template is suitable for your circumstances. You can use our Public Library to search based on criteria such as industry and subject matter. Search results are based on their relevance to your search and other criteria. We may feature checklists based on subject matters we think may be of interest to our customers.