Title Page

  • simPRO Job No.

  • ROW, SDU, MDU or Other

  • What work was completed

  • Site Address

  • Prepared by

  • Vehicle Rego

  • Lead Tech

  • Assistant Tech

  • Conducted on

Site Observations

  • Is the site meeting safety expectations?

  • Was the Induction helpful or not?

  • Have they identified and controlled all of the significant hazards?

  • Are there any new hazards to consider?

  • Was the site tidy or presented well?

  • Are the techs confident to do the job safely?

  • PPE (As per task requirements)?

  • Did they explain the task and controls well?

  • Has the JSA captured these controls?

  • What are the techs considering, from a safety perspective, when they start the task?

  • Do the techs consider other people (public, workers, home owners) when they do their tasks?

  • Is the other (vehicle, generator, tools etc) equipment tidy and in good condition?

Site Safety Improvements

  • Please list the Good Safety Behaviors?

  • Good Safety Behaviors

  • Unsatisfactory Behaviors (e.g. hazards, controls and at-risk behavior)

  • Unsatisfactory Behaviors (e.g. hazards, controls and at-risk behavior)

  • Safety Discussion and Immediate Actions required?

  • Photos of rectifications

  • Future Improvements/ Training?


  • Manager Name

  • Technician
  • Technician Name

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.