Information
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Date and Time of Observation
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Location
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Specific Work Area of Observation
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Observer Name
Category
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RP - Reactions of People
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- UC - Unsafe Condition
- UA - Unsafe Act
- SA - Safe Act
- SC - Safe Condition
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PP - Positions of People
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- UC - Unsafe Condition
- UA - Unsafe Act
- SA - Safe Act
- SC - Safe Condition
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PPE - Personal Protective Equipment
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- UC - Unsafe Condition
- UA - Unsafe Act
- SA - Safe Act
- SC - Safe Condition
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PTE - Plant / Tools & Equipment
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- UC - Unsafe Condition
- UA - Unsafe Act
- SA - Safe Act
- SC - Safe Condition
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PR - Procedures
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- UC - Unsafe Condition
- UA - Unsafe Act
- SA - Safe Act
- SC - Safe Condition
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ER - Ergonomics
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- UC - Unsafe Condition
- UA - Unsafe Act
- SA - Safe Act
- SC - Safe Condition
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HK - Housekeeping
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- UC - Unsafe Condition
- UA - Unsafe Act
- SA - Safe Act
- SC - Safe Condition
Contributing Hazards
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Authority to Work
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Behavioral
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Environmental
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Fitness for Work
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Energy
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Hazardous Events
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Hazardous Substances
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Fixed Plant
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Mobile Plant
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Facilities / Sites
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N/A ( only select if all items in the first Category were SA or SC)
Safety Observation or Hazard ID Details- enter details and items that were corrected or need correction in this section
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1) Item Detail ( move slider to right to enter information)
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Corrective Action Required
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By whom is the action required?
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Date and time action was completed
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2) Item Detail ( move slider to right to enter information)
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Corrective Action Required
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By whom is the action required?
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Date and time action was completed
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3) Item Detail ( move slider to right to enter information)
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Corrective Action Required
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By whom is the action required?
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Date and time action was completed
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4) Item Detail ( move slider to right to enter information)
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Corrective Action Required
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By whom is the action required?
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Date and time action was completed
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5) Item Detail ( move slider to right to enter information)
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Corrective Action Required
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By whom is the action required?
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Date and time action was completed
Additional Thoughts & Comments
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Completed audit/inspection needs to be sent to the assigned Manager and Supervisor of area for corrective actions to be addressed and to the Health and Safety Department for record keeping.
