• Date / Time of Observation

  • Contractor Observed

  • Specific Location

  • Insert column Location, a Picture or Other Comments Here

  • Number of Employees Observed

  • Observer

Any Marked "At Risk" Must Include Details and a photo.

  • Face / Eye PPE

  • Foot PPE

  • Hand / Arm PPE

  • Head PPE

  • Hearing PPE

  • Respiratory PPE

  • Fall Protection

  • Mobile Equipment

  • Electrical / GFCI

  • Lockout / Tagout

  • Work Permits

  • Excavations

  • Hot Work

  • Storage Area

  • Manual Lifting

  • Ladders

  • Scaffolds

  • Access

  • Aerial Lifts

  • Barricades / Signs

  • Slips / Trips / Falls

  • Lifting / Rigging

  • Confined Space

  • Equipment / Tools

  • Housekeeping

  • Lighting

  • Chemical

  • Other

  • Audit Conducted by:

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