Safe Act Observation

• Audit Title

• Document No.

• Prepared by

• Select date

  Date
• Location
  Address

Act observed.

• Task

• Section

• Select date

  Date

• Department.

• Job number.

Act observed

• Is take 5 complete

  Yes

  No

  N/A

• Correct isolation and tagging

  Yes

  No

  N/A

• Correct ppe being used

  Yes

  No

  N/A

• Is house keeping aceptable

  Yes

  No

  N/A

• Is hot work permit complete

  Yes

  No

  N/A

• Is there confined space risk

  Yes

  No

  N/A

• Is there working at heights risk

  Yes

  No

  N/A

• Other observations

• Add media

  Media

Observers should acknowledge employee being observed and encourage there evolvement by adding comment.

• Employee name

• Employee job title

• Employee comments.