Date / Time of Walk starting
Companies represented on walk
Disciplinary Action given

First and last name of worker

Description of violation

Level of severity (could be escalated if additional violations exist in the disciplinary log)


Foreman Signature indicating the violation was explained to the worker and understood.
Corrective Action

Area location

Detail issue

Add media

Detail Corrective Action needed

Due date

Check box if verified complete

Check the area in accordance with the below criteria.
Any corrective actions should be documented in the next section.
Any marked "No" should have a detailed explanation.
Area walked

Area location

All PTPs checked for completeness

All personnel protected from potential falls

All holes adequately covered and labeled

All personnel wearing required PPE

All barricades in place appropriate with up to date signage

Housekeeping up to client expectations

Cords inspected and elevated above walking surfaces

Material stored off ground in yellow rope areas with signs

Walking surfaces in acceptable condition

Access and egress sufficient

All equipment inspections current

Secondary containment in place under equipment

Other deficiency not captured on the list above

Comments on the area

Time of walk finishing
Name of Auditor and Signature
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.