New Version F0027 Health, Safety and Environmental Tour Report form

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Hazards Identified and rectified on site

• Were Any Hazards identified (Create and Action if YES)

  Yes

  No

  N/A

• If hazard identified are they safe or is there risk associated with the hazard (if risk create action)

  Safe

  At Risk

  N/A

• Further Details of hazards identified

• Photos of hazards identifed

  Media

Details of any health, safety and environmental deviations seen and actions taken to remedy

• Were any health, safety and environmental deviations seen (create action if yes)

  Yes

  No

  N/A

• Further Details of health, safety and environmental deviations seen

• If applicable please add Photo of Action taken to remedy

  Media

Actions identified

• Are ALL actions identified been rectified on site (if NO create and action)

  Yes

  No

  N/A

• Any Further Details of action to be taken to remedy

• Add signature

  Sign

Number of People Interactions

• The number of people you spoke to where you both discussed safe & unsafe items

  1

  2

  3

  4+

  N/A

• Details of what you both discussed

Positive Behavioural Health, Safety and Environmental Actions/areas identified/matters raised by staff

• Any Positive Behavioural observations seen (if YES create and Action)

  Yes

  No

  N/A

• Further Details of Positive Behavioural observations seen

• Are there any actions/areas identified/matters raised by staff (if YES create action)

  Yes

  No

  N/A

• Further Details of any Actions / Areas identified / Matters raised by staff

Commendable Health, Safety and Environmental Actions Observed

• Were there any Commendable Health, Safety and Environmental Actions Observed (if YES create action)

  Yes

  No

  N/A

• Extra Details of Commendable Health, Safety and Environmental Actions Observed

• Add signature

  Sign