Information
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
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Tour
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Conversation
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Condition Report
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Describe what was seen.
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What was the conversation? What was discussed?
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What was agreed?
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Observer
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Leader
The Agreement
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Reinforce Safe Behavior
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Changed Unsafe Behavior / Condition
Job Position
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Drill Crew
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Deck Crew
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Marine Crew
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Maintenance Crew
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Other
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Third Party
Location
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Rig Floor
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Pipe Deck
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Machinery Space
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Accomodations
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Other
Behaviors / Hazards
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Poor Housekeeping
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Tools & Equipment
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Electrical Energy
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Pressure
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Struck By
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Caught Between
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Fire / Explosion
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Other
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Incorrect PPE
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Impaired
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Dropped Objects
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Loss of Containment
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Falling
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Marine Integrity
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Well Control
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Environment
Requirements / Procedures
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Not Known
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Not followed
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Not understood
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Inadequate
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I certify work is safe to restart
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Observer
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UWA
