SAFETY ANALYSIS FIELD ENGAGEMENT

• Site conducted

  Select

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Critical States (People)

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

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

• Rushing

  Safe

  At Risk

  N/A

• Balance traction or grip

  Safe

  At Risk

  N/A

Line of fire (Hazards)

• PPE (required, used correctly, good condition)

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

• Isolation (lockout, tags, switching)

  Safe

  At Risk

  N/A

• Area housekeeping

  Safe

  At Risk

  N/A

Body mechanics (people)

• Lifting, bending, twisting

  Safe

  At Risk

  N/A

• Repetitive motions

  Safe

  At Risk

  N/A

• Excessive reaching, pulling, pushing

  Safe

  At Risk

  N/A

• Standing, sitting, kneeling for long periods

  Safe

  At Risk

  N/A

• Comfortable (versus awkward position)

  Safe

  At Risk

  N/A

Permits, procedures and standards

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

  Safe

  At Risk

  N/A

Tools and equipment

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

  Safe

  At Risk

  N/A

• Correct tool used for each task

  Safe

  At Risk

  N/A

• Tools and equipment used safety

  Safe

  At Risk

  N/A

Brief description of the task observed

• Add drawing

  Drawing

Safe acts observed

• Add drawing

  Drawing

Unsafe acts/conditions observed

• Add drawing

  Drawing

Opportunities for improvement

• Add drawing

  Drawing

• Recorded into Guardian

  Date

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

  Yes

  No

  N/A

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

  Sign

• Select date

  Date