CATS Report

• Conducted on

  Date
• Location
  Address

• Prepared by

Reporting

• Provide initial description of Act(s) Observed

• Was The Observed Activity Safe or Unsafe?

  Safe

  Unsafe

• Please select a category from the list below & subsequent detail

• Act Observed

  Select PPE Tools & Equipment Housekeeping Behaviour Procedural Training

  • PPE
  • Tools & Equipment
  • Housekeeping
  • Behaviour
  • Procedural
  • Training

• PPE - Further Detail

  Select Head Eyes Ears Respiratory Hands Feet Harness / Lanyard Hi Vis

  • Head
  • Eyes
  • Ears
  • Respiratory
  • Hands
  • Feet
  • Harness / Lanyard
  • Hi Vis

• Tools & Equipment - Further Detail

  Wrong for job

  Used Incorrectly

  In Unsafe Condition

• Housekeeping - Further Detail

  Select Housekeeping Standards not known or understood Housekeeping standards not being followed

  • Housekeeping Standards not known or understood
  • Housekeeping standards not being followed

• Behaviour - Further Detail

  Select Adjusting PPE Changing Position Rearranging Job Stopping Job Horseplay Inattention to Surroundings

  • Adjusting PPE
  • Changing Position
  • Rearranging Job
  • Stopping Job
  • Horseplay
  • Inattention to Surroundings

• Procedural - Further Detail

  Select Procedures Are Inadequate Procedure is Not Known/Understood Procedure not being Followed Risk Assessment Safe system of work

  • Procedures Are Inadequate
  • Procedure is Not Known/Understood
  • Procedure not being Followed
  • Risk Assessment
  • Safe system of work

• Training - Further Detail

  Select Person(s) Not trained for the Activity Person(s) Not induction trained Other training not completed

  • Person(s) Not trained for the Activity
  • Person(s) Not induction trained
  • Other training not completed

• Remedial Action Taken

• Please select a category from the list below

• Act Observed

  Select PPE Tools & Equipment Housekeeping Behaviour Procedural Training

  • PPE
  • Tools & Equipment
  • Housekeeping
  • Behaviour
  • Procedural
  • Training

• Please Add Notes To Why Safe?

Additional Activities Observed

Observation

• Provide initial description of Act(s) Observed

• Was The Observed Activity Safe or Unsafe?

  Safe

  Unsafe

• Please select a category from the list below & subsequent detail

• Act Observed

  Select PPE Tools & Equipment Housekeeping Behaviour Procedural Training

  • PPE
  • Tools & Equipment
  • Housekeeping
  • Behaviour
  • Procedural
  • Training

• PPE - Further Detail

  Select Head Eyes Ears Respiratory Hands Feet Harness / Lanyard Hi Vis

  • Head
  • Eyes
  • Ears
  • Respiratory
  • Hands
  • Feet
  • Harness / Lanyard
  • Hi Vis

• Tools & Equipment - Further Detail

  Wrong for job

  Used Incorrectly

  In Unsafe Condition

• Housekeeping - Further Detail

  Select Housekeeping Standards not known or understood Housekeeping standards not being followed

  • Housekeeping Standards not known or understood
  • Housekeeping standards not being followed

• Behaviour - Further Detail

  Select Adjusting PPE Changing Position Rearranging Job Stopping Job Horseplay Inattention to Surroundings

  • Adjusting PPE
  • Changing Position
  • Rearranging Job
  • Stopping Job
  • Horseplay
  • Inattention to Surroundings

• Procedural - Further Detail

  Select Procedures Are Inadequate Procedure is Not Known/Understood Procedure not being Followed Risk Assessment Safe system of work

  • Procedures Are Inadequate
  • Procedure is Not Known/Understood
  • Procedure not being Followed
  • Risk Assessment
  • Safe system of work

• Training - Further Detail

  Select Person(s) Not trained for the Activity Person(s) Not induction trained Other training not completed

  • Person(s) Not trained for the Activity
  • Person(s) Not induction trained
  • Other training not completed

• Remedial Action Taken?

• Please select a category from the list below

• Act Observed

  Select PPE Tools & Equipment Housekeeping Behaviour Procedural Training

  • PPE
  • Tools & Equipment
  • Housekeeping
  • Behaviour
  • Procedural
  • Training

• Please Add Notes To Why Safe?

• Completed by

  Sign