Title Page

  • Client / Site

  • Conducted on

  • Conducted by

Inspection: PM

    FINDING
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  • Deficiency:

  • Supporting Regulation/Documentation:

  • Corrective Actions:

  • Timeline for Corrective Actions:

Inspection: SITE RESPONSIBILITY

PROPERTY MANAGEMENT RESPONSIBILITY

    Finding
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RISK LEVEL

  • SEVERITY

  • Insignificant - Illness, injury requiring first aid or no treatment.
    - No disruption to operations.
    - No public relations impact.
    - No security element impact.

  • Minor - Medical (doctor) treatment.
    - Brief disruption to operations.
    - Minor errors in completed Company policy/procedures.

  • Moderate - Single serious injury.
    - Definite disruption to operations.
    - Non-life threatening injury, with lost time recorded.
    - Additional public relations efforts and resources required.

  • Major - Single death or major permanent disablement.
    - Partial loss of operations.
    - Major potential for $$$ fines.
    - Incident with injuries and/or major to moderate equipment damage.
    - Medium environmental impact.
    - Very large public relations impact requiring resources to manage information.

  • Catastrophic - Multiple deaths.
    - Substantial or total loss of operations.
    - Equipment destroyed.
    - Single or multiple deaths.
    - Large environmental Impact.
    - Willful violation of any safety regulation that could result in serious injury or death.
    - Potential for uncontrollable public relations event(s).

  • PROBABILITY

  • Rare - The unwanted event has never been known to occur in the industry but could happen if the conditional were right.

  • Unlikely - Unlikely that workers, employees, contractors or visitors will come into contact with this hazard when performing daily tasks. > The unwanted event has happened in the relevant industry; or has happened in the last 10 years.

  • Possibly - Possible that workers, employees, contractors or visitors will come into contact with this hazard when performing a specific task. > The unwanted event has happened in the company in the last 5 years.

  • Likely - Likely that workers, employees, contractors or visitors will come into contact that this hazard once every few days or when working on that specific area. > The unwanted event could occur several times a year within the company.

  • Almost Certain - Almost certain that workers, employees, contractors and visitors will come into contact with this hazard each shift or multiple times per shift. > The unwanted event could occur several times per year at this location.

  • RISK LEVEL

  • Acceptable but with continued data collection and trending for continuous improvement needed.

  • Manageable under risk control & mitigation. Requires management decision.

  • Unacceptable under existing circumstances requires immediate action.

FINDING INFORMATION

  • Deficiency:

  • Supporting Regulation/Documentation:

  • Corrective Actions:

  • Timeline for Corrective Actions:

Questions

    Question
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  • Info:

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.