PJO Safety Observation

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Observation Reason

• Reason For Observation

  Select New Worker Training Transferred Employee Hazardous Task Incident Follow up Procedure Review Other

  • New Worker
  • Training
  • Transferred Employee
  • Hazardous Task
  • Incident Follow up
  • Procedure Review
  • Other

PPE

• High Visabillity Clothing

  Yes

  No

  N/A

• Hard Hat

  Yes

  No

  N/A

• Gloves

  Yes

  No

  N/A

• Steel Toe Boots

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Personal Safety Assessment

• 5x5 Filled out?

  Yes

  No

  N/A

• JHA completed for the task at hand?

  Yes

  No

  N/A

Observation

• 1. Safe Practices Observed:

• Positive Feedback:

• Substandard Acts Observed:

• Corrective Actions:

Sub Standard Observations

Standards, Procedures, Work Instructions, JRA:

• Nothing in place

  Yes

  No

  N/A

• Person unaware

  Yes

  No

  N/A

• Not followed

  Yes

  No

  N/A

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