Information

  • Project Name

  • Job Number

  • Project Supervisor

  • Conducted on

  • Prepared by

Was daily safety check completed?

  • Were equipment inspections completed?

Housekeeping

  • Aisles/Walkways kept clear?

  • Work area kept organized?

  • Housekeeping: spills, cords or other trips, trash/clutter, lighting, or Flammables

Personal Protective Equipment

  • All appropriate equipment or gear worn correctly?

  • PPE kept in good condition?

  • Personal protective equipment: hand, body, eyes/face, head, foot, respiratory, fall protection, hearing protection, or FR clothing/gear

Working Position

  • Body position

  • Location in working environment

  • Working Position: poor posture, over stretched, above shoulder, below knees, twisting, caught in between, struck by, working at heights greater than 4', floor or wall opening, unprotected work edge, or false ceiling or floor.

Tools and Equipment

  • Appropriate tools or equipment being used?

  • Tools or equipment being used correctly?

  • Tools or equipment in good condition?

  • Tools and equipment: ladders, power or hand tools

Safe behaviors observed-actions taken to encourage safe behavior

Unsafe behaviors observed-action taken to correct and prevent recurrence

Line of fire. Is the worker in the line of fire?

  • Grinding or drilling operations creating flying objects or particles - goggles/face-shield in use?

  • Equipment movement in the area - operator aware of employees and pedestrians?

Safety procedures

  • Lock-out/Tag-out, Hot Work Permit, Confined Space, Trench Log

  • Add media

  • Auditor 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. You should independently determine whether the template is suitable for your circumstances.