BBS

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Job at hand

• Line of fire?

  Safe

  At Risk

  N/A

• Focused on job at hand?

  Safe

  At Risk

  N/A

• Eyes on hand/task?

  Safe

  At Risk

  N/A

• Asc/Des/Access/Egress

  Safe

  At Risk

  N/A

• Pinch points?

  Safe

  At Risk

  N/A

Body use/Position

• Pushing/Pulling

  Safe

  At Risk

  N/A

• Lifting/Lowering

  Safe

  At Risk

  N/A

• Twisting

  Safe

  At Risk

  N/A

• Over exertion /Cramped

  Safe

  At Risk

  N/A

• Repetitive Motion

  Safe

  At Risk

  N/A

Procedures

• Standard/Adequate?

  Yes

  No

  N/A

• Standard/Followed?

  Yes

  No

  N/A

• Permits?

  Yes

  No

  N/A

• Not known/ not understood?

  Safe

  At Risk

  N/A

• Safety absolutes adhered?

  Yes

  No

  N/A

Tools and Equipments

• Tool selection used

  Safe

  At Risk

  N/A

• Right tool /Equipment

  Yes

  No

  N/A

• Equipment Condition

  Safe

  At Risk

  N/A

• Mobile equipment use /spotter used?

  Safe

  At Risk

  N/A

• Tool/equipment Inspection

  Safe

  At Risk

  N/A

PPE

• Head

  Yes

  No

  N/A

• Eyes and Face

  Safe

  At Risk

  N/A

• Hearing

  Safe

  At Risk

  N/A

• Respiratory

  Safe

  At Risk

  N/A

• Body

  Safe

  At Risk

  N/A