• Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel


  • Observers name

  • Employee observed

  • Date and time of observation

  • Select Department where observation occurred


  • Describe each at risk behavior

  • At Risk Behavior
  • Describe behavior observed

  • Add media

  • Describe preventative action discussed with employee

  • Describe positive behaviors observed


  • Observer name and signature

  • Observer 2 name and signature

  • Employee name and signature

Safety Committee Review

  • Comments - Recommendations

  • Review Date

  • General Manager 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.