Title Page

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

SAFETY SHARE & HEALTH CHECK

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SAFETY -Safe Home Everyday

  • Was the day minor incident or near miss free?

  • Was the day major incident free?

COST

  • Was daily tonnage target achieved?

QUALITY - Specs

  • Were there any quality issues with incoming grain?

TODAYS ACTIVITIES & JOB REQUIREMENTS

  • Provide details of the day's planned activities and any controls put in place to mitigate risk

  • Were any new or high risk activities identified? If yes please give details & provide image of JSA or TAKE 5

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BREAKDOWNS & CALLS FOR HELP

  • Enter photo of any damage here:

RECOGNITION

  • Name & Reason

SIGNATURES

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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.