• Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Part A - Task being observed

Observation Team Members


Time of observation

Safe Act Observation Checklist

Risk Assessment

  • Risk assessment required and completed?

  • Risk assessment followed if required?

  • Required permits in place?


  • Passageways clear of fire hazards?

  • Area free from possible trips / slip hazards?

  • Area free of rubbish?


  • Seat belts worn?

  • Driving regulations / condition compliance?

  • Correct license / permit?

  • Pre-start check / vehicle condition?

Tools & Equipment

  • Right Tools?

  • Condition & Use?

  • MSDS required & approved?

  • Correct slings used?

  • Correct harness / lanyard used?

Personal Protective Equipment

  • Hard hats / bump caps?

  • Safety glasses?

  • High visual vest / shirt?

  • Safety shoes?

  • Task specific PPE (Respirators / gloves / dust masks)?

Isolation & Tagging

  • Positive Isolation?

  • Lock-out tags in place?

People Positions

  • Barricades in place?

  • Access control?

  • Safe positions in work area (stand-off distances)?

Procedure Compliance

  • Procedure adequate?

  • Procedure understood & followed?


  • Are all waste disposed correctly?

  • Adequate dust suppression?

Part B - Corrective action

  • Unsafe condition / behaviour corrected?

Corrective Action

Part C - Personnel Involved

  • Discussions held with responsible person(s)?

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