• 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

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