Information

  • Audit Title

  • Document No.

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Critical States (People)

  • Mind on task (Concentrating and aware of environment)<br>

  • Eyes on task (looking at what they are doing and where the are going)

  • Rushing

  • Balance traction or grip

Line of fire (Hazards)

  • PPE (required, used correctly, good condition)

  • Body position (falling, struck by, pinch points etc)

  • Guards, barriers, rails, traffic controls, safety observers

  • Isolation (lockout, tags, switching)

  • Area housekeeping

Body mechanics (people)

  • Lifting, bending, twisting

  • Repetitive motions

  • Excessive reaching, pulling, pushing

  • Standing, sitting, kneeling for long periods

  • Comfortable (versus awkward position)

Permits, procedures and standards

  • Are all permits, procedures and standards current, readily available, understood and followed

Tools and equipment

  • Safe condition (pre-start checks completed, checked and tagged)

  • Correct tool used for each task

  • Tools and equipment used safety

Brief description of the task observed

  • Add drawing

Safe acts observed

  • Add drawing

Unsafe acts/conditions observed

  • Add drawing

Opportunities for improvement

  • Add drawing

  • Recorded into Guardian

  • If actions assigned to someone not involved with the observation, has courtesy contact been made?

  • Site controller sign off (to confirm observation took place)

  • Select date

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.