MBAC Safety Observation Log

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Safety Observation 1

• Task Observed

  Safe

  At Risk

  N/A

• Class

  Select Safe Act Safe Condition Unsafe Act Unsafe Condition Haza / Near Miss Environmental

  • Safe Act
  • Safe Condition
  • Unsafe Act
  • Unsafe Condition
  • Haza / Near Miss
  • Environmental

• Category

  Select Housekeeping PPE Violations Procedures Tools and Equipment Lifting and Rigging Traffic Management Working at Heights Health and Environmental

  • Housekeeping
  • PPE Violations
  • Procedures
  • Tools and Equipment
  • Lifting and Rigging
  • Traffic Management
  • Working at Heights
  • Health and Environmental

• Immediate Action?

  Yes

  No

  N/A

• Follow Up Actions?

  Yes

  No

  N/A

• Responsible Person?

  Yes

  No

  N/A

• Select date

  Date

Safety Observation 2

• Task Observed

  Safe

  At Risk

  N/A

• Class

  Select Safe Act Safe Condition Unsafe Act Unsafe Condition Haza / Near Miss Environmental

  • Safe Act
  • Safe Condition
  • Unsafe Act
  • Unsafe Condition
  • Haza / Near Miss
  • Environmental

• Category

  Select Housekeeping PPE Violations Procedures Tools and Equipment Lifting and Rigging Traffic Management Working at Heights Health and Environmental

  • Housekeeping
  • PPE Violations
  • Procedures
  • Tools and Equipment
  • Lifting and Rigging
  • Traffic Management
  • Working at Heights
  • Health and Environmental

• Immediate Action?

  Yes

  No

  N/A

• Follow Up Actions?

  Yes

  No

  N/A

• Responsible Person?

  Yes

  No

  N/A

• Select date

  Date

Safety Observation 3

• Task Observed

  Safe

  At Risk

  N/A

• Class

  Select Safe Act Safe Condition Unsafe Act Unsafe Condition Haza / Near Miss Environmental

  • Safe Act
  • Safe Condition
  • Unsafe Act
  • Unsafe Condition
  • Haza / Near Miss
  • Environmental

• Category

  Select Housekeeping PPE Violations Procedures Tools and Equipment Lifting and Rigging Traffic Management Working at Heights Health and Environmental

  • Housekeeping
  • PPE Violations
  • Procedures
  • Tools and Equipment
  • Lifting and Rigging
  • Traffic Management
  • Working at Heights
  • Health and Environmental

• Immediate Action?

  Yes

  No

  N/A

• Follow Up Actions?

  Yes

  No

  N/A

• Responsible Person?

  Yes

  No

  N/A

• Select date

  Date

Safety Observation 4

• Task Observed

  Safe

  At Risk

  N/A

• Class

  Select Safe Act Safe Condition Unsafe Act Unsafe Condition Haza / Near Miss Environmental

  • Safe Act
  • Safe Condition
  • Unsafe Act
  • Unsafe Condition
  • Haza / Near Miss
  • Environmental

• Category

  Select Housekeeping PPE Violations Procedures Tools and Equipment Lifting and Rigging Traffic Management Working at Heights Health and Environmental

  • Housekeeping
  • PPE Violations
  • Procedures
  • Tools and Equipment
  • Lifting and Rigging
  • Traffic Management
  • Working at Heights
  • Health and Environmental

• Immediate Action?

  Yes

  No

  N/A

• Follow Up Actions?

  Yes

  No

  N/A

• Responsible Person?

  Yes

  No

  N/A

• Select date

  Date

Safety Observation 5

• Task Observed

  Safe

  At Risk

  N/A

• Class

  Select Safe Act Safe Condition Unsafe Act Unsafe Condition Haza / Near Miss Environmental

  • Safe Act
  • Safe Condition
  • Unsafe Act
  • Unsafe Condition
  • Haza / Near Miss
  • Environmental

• Category

  Select Housekeeping PPE Violations Procedures Tools and Equipment Lifting and Rigging Traffic Management Working at Heights Health and Environmental

  • Housekeeping
  • PPE Violations
  • Procedures
  • Tools and Equipment
  • Lifting and Rigging
  • Traffic Management
  • Working at Heights
  • Health and Environmental

• Immediate Action?

  Yes

  No

  N/A

• Follow Up Actions?

  Yes

  No

  N/A

• Responsible Person?

  Yes

  No

  N/A

• Select date

  Date

Safety Observation 6

• Task Observed

  Safe

  At Risk

  N/A

• Class

  Select Safe Act Safe Condition Unsafe Act Unsafe Condition Haza / Near Miss Environmental

  • Safe Act
  • Safe Condition
  • Unsafe Act
  • Unsafe Condition
  • Haza / Near Miss
  • Environmental

• Category

  Select Housekeeping PPE Violations Procedures Tools and Equipment Lifting and Rigging Traffic Management Working at Heights Health and Environmental

  • Housekeeping
  • PPE Violations
  • Procedures
  • Tools and Equipment
  • Lifting and Rigging
  • Traffic Management
  • Working at Heights
  • Health and Environmental

• Immediate Action?

  Yes

  No

  N/A

• Follow Up Actions?

  Yes

  No

  N/A

• Responsible Person?

  Yes

  No

  N/A

• Select date

  Date