RA Document

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

**** Describe what Occured ****

• Names and no. employees; any witnesses; any plant or equipment used; time of the day or night; any other factors?

  Safe

  At Risk

  N/A

**** What could be done to prevent a repeat? ****

• Please Explain?

  Safe

  At Risk

  N/A

• Date Operations Team was notified?

  Date

• Date Operations Team conducted risk assessment?

  Date

• Monthly SHEC Meeting where findings were discussed?

  Yes

  No

  N/A

• Select date

  Date

• Venue Manager

  Sign

• Area Manager

  Sign