Acts
Adjusting Personal Protective Equipment?
Changing Postion?
Rearranging Job?
Stopping Job?
Attaching Grounds?
Performing Locks?
Striking Against or Being Struck by Objects
Caught In, On, or Between Objects
Falling
Contacting Temperature Extremes
Contacting Electric Current
Inhaling, Absorbing, or Swallowing a Hazardous Substance
Repetitive Motions
Awkward Positions/Static Postures
Head
Eyes and Face
Ears
Respiratory System
Arms and Hands
Trunk
Legs and Feet
Right for the Job?
Used Correctly?
In Safe Condition?
Available?
Adequate?
Known?
Understood?
Followed?
Known?
Understood?
Followed?
REMEMBER-Do not mention the names of employes in this section!
Unsafe Acts Observed
REMEMBER-Do not mention the names of employes in this section!
Safe Acts Observed
Conditions
Right for the job?
In Safe Condition?
Clean?
Orderly?
Right for the job?
In Safe Condition?
Clean?
Orderly?
In Safe Condition?
Neat and in good order?
Additional info
REMEMBER-Do not mention the names of employees in this section!
Additional information gathered from talking to employee.
Time taken on audit
