Integrated Facility Services Safe Observation Form

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Risk Assessment

• Was a Job Hazard Analysis performed?

  Yes

  No

  N/A

Access to work area

• Is the employee able to access the work area safely?

  Yes

  No

  N/A

• Was the employee able to get all material to the work area safely?

  Yes

  No

  N/A

Housekeeping

• Aisles/Walkways kept clear?

  Yes

  No

  N/A

• Work area kept organized?

  Yes

  No

  N/A

• Housekeeping: cords, or other trip hazards, trash/clutter, lighting, or flammables

  Safe

  At Risk

  N/A

Personal Protective Equipment

• All appropriate equipment or gear worn correctly?

  Yes

  No

  N/A

• PPE kept in good condition?

  Yes

  No

  N/A

• Personal Protective Equipment: hand, body, eyes/face, head, foot, respiratory, fall protection, hearing protection, and FR clothing/gear.

  Safe

  At Risk

  N/A

Tools and Equipment

• Appropriate tools and equipment being used correctly?

  Yes

  No

  N/A

• Tools and equipment in good condition?

  Yes

  No

  N/A

• Tools and equipment: ladders, power and hand tools, rigging, and torches.

  Safe

  At Risk

  N/A

Working Position

• Body position

  Safe

  At Risk

  N/A

• Working Position: poor posture, over stretched, above shoulder, below knees, twisting, caught in between, struck by, working at heights, floor or wall opening, unprotected work edge, or false ceiling or floor.

  Safe

  At Risk

  N/A

Safety Procedures

• Is the employee using proper Lock Out/ Tag Out equipment?

  Safe

  At Risk

  N/A

• Is the employee exposed to any fall hazards?

  Safe

  At Risk

  N/A

• Does the site require a hot work permit?

  Safe

  At Risk

  N/A

• Any Confined Space issues?

  Safe

  At Risk

  N/A

• Is a crane being used to hoist material?

  Safe

  At Risk

  N/A

• Is the employee working in any excavations?

  Safe

  At Risk

  N/A

• Are there any chemical hazards?

  Safe

  At Risk

  N/A

Safe behaviors observed.

• What actions were taken to provide positive feedback?

  Action Taken

Unsafe behaviors observed

• What actions were taken to correct and prevent recurrence?

  Action Taken

Follow Up

• Items for follow up/ action taken

  Action Taken