• Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • Task being undertaking during Observation.<br>

  • Was Training provided? If so, what was shown? Who was shown?

  • Was the training understood?<br>

  • Feedback

  • Add media

  • Corrective Actions Needed: Reported to:

  • Any compliance or behavioural issues identified that should be entered into the Nitro Incident Report System

  • Incident Report No: And Reported to:

  • Observer Signature:

Standards, Procedures, Work Instructions, JRA:

  • Correct SWP or JHA in place

  • All Persons aware

  • SWP followed correctly

  • SWP No's:

Personal Protective Equipment / Clothing:

  • Correct type / Appropriate for job

  • Used correctly

Tools / Equipment used for task:

  • Correct type / appropriate for job

  • Tool used correctly

  • In serviceable condition

General Evaluation:

  • Trapped in, on or between moving parts

  • Manual Handing

  • Strain / Over-exertion

  • Constant repetitive actions

  • Contact extreme hot or cold

  • Hazardous substances? MSDS? Storage?


  • Area assessed for suitability before start

  • Area kept tidy during the task

  • Area left tidy after task completed <br>

Isolation / Pre start:

  • All isolation points identified

  • Isolation performed correctly

  • Pre starts preformed as required

  • Other:

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.