Hazard Observation Card - Local

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Select date

  Date

• Team Member Observed

• Team Member Department

Unsafe Conditions

• Trip/Slip Hazard

• Please Describe

• Housekeeping

• Please Describe

• Equipment

• Please Describe

• Other

• Please Describe

Unsafe Behaviors

• Body Position

• Please Describe

• Safe Procedures

• Please Describe

• Eyes on Task

• Please Describe

• Mind on Task

• Please Describe

• Other

• Please Describe

• Signature of Observer

  Sign