Information

  • Site conducted

  • Document No.

  • Audit Title

  • Site

  • Conducted on

  • Prepared by

  • Personnel Present

Body Mechanics

  • Is your footing or position safe? List unsafe acts observed and/or corrective actions taken.

  • Is the employee using proper lifting techniques? List unsafe acts observed and/or corrective actions taken.

  • Are any pinch points present? List pinch points observed and/or corrective actions taken.

  • Is the employee overextending? List unsafe acts observed and/or corrective actions taken.

  • Is the employee pulling or twisting while working? List unsafe acts observed and/or corrective actions taken.

Tools & Equipment

  • Are the proper tools and equipment being used? List unsafe acts observed and/or corrective actions taken.

  • Are the tools and/or equipment being used in good condition? List unsafe acts observed and/or corrective actions taken.

PPE

  • Eye Protection

  • Hand protection

  • Hearing protection

  • Respirator

  • Clothing/FR Clothing

  • Fall Protection

Operating Procedures

  • Pre-job or task STOP card completed

  • Following SJP or Standard Work?

  • Chemical safety

  • Housekeeping conditions?

  • LO/TO required?

  • Confined space entry required?

Individuals participating in observation

  • Employee conducting observation

  • Employee being observed

  • Task being observed

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.