Information
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Conducted on
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Prepared by
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Location
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Company Contact
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Company Contact Phone
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Company Contact Email
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Owner/ GC/ Sub-tier/ Other
Perception questions
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Have you voiced any safety concerns on this project? Have they been acted upon?
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How is your day?
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What is the biggest hazard for you on this project?
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How are we treating you?
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Do you have the authority to stop work? Have you exercised that authority?
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Do you have the tools and resources to do your job?
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What could we do better in relation to safety?
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Have you received adequate training?
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Describe how discipline is handled for safety issues.
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Is your company more concerned about their safety record than about incident prevention?
Site Visit Summary
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Summary of findings from audit team. (Site appearance, safety culture demonstrated by site personnel, thoughts for improvement, any follow ups needed by contractors onsite, or perception survey experience.)
