Information
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Audit Title
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Document No.
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
Critical States (People)
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Mind on task (Concentrating and aware of environment)<br>
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Eyes on task (looking at what they are doing and where the are going)
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Rushing
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Balance traction or grip
Line of fire (Hazards)
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PPE (required, used correctly, good condition)
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Body position (falling, struck by, pinch points etc)
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Guards, barriers, rails, traffic controls, safety observers
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Isolation (lockout, tags, switching)
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Area housekeeping
Body mechanics (people)
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Lifting, bending, twisting
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Repetitive motions
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Excessive reaching, pulling, pushing
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Standing, sitting, kneeling for long periods
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Comfortable (versus awkward position)
Permits, procedures and standards
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Are all permits, procedures and standards current, readily available, understood and followed
Tools and equipment
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Safe condition (pre-start checks completed, checked and tagged)
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Correct tool used for each task
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Tools and equipment used safety
Brief description of the task observed
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Add drawing
Safe acts observed
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Add drawing
Unsafe acts/conditions observed
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Add drawing
Opportunities for improvement
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Add drawing
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Signature of person conducting field engagement
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Select date