Safety Inspection Report

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Before or After Construction

  Before

  After

Hazard #1

• Name the Hazard

• Evaluate the Hazard; Pick 2.

  Select Imminent Danger Serious Minor Acceptable Not Applicable Probable Reasonably Probable Remote Extremely Remote

  • Imminent Danger
  • Serious
  • Minor
  • Acceptable
  • Not Applicable
  • Probable
  • Reasonably Probable
  • Remote
  • Extremely Remote

• Code of the Hazard

  Select Worksites Work Practices Projective Equipment Tools Equipment Vehicles

  • Worksites
  • Work Practices
  • Projective Equipment
  • Tools
  • Equipment
  • Vehicles

• Action Taken

• Name the Hazard

Hazard #2

• Name the Hazard

• Evaluate the Hazard; Pick 2.

  Select Imminent Danger Serious Minor Acceptable Not Applicable Probable Reasonably Probable Remote Extremely Remote

  • Imminent Danger
  • Serious
  • Minor
  • Acceptable
  • Not Applicable
  • Probable
  • Reasonably Probable
  • Remote
  • Extremely Remote

• Code of the Hazard

  Select Worksites Work Practices Projective Equipment Tools Equipment Vehicles

  • Worksites
  • Work Practices
  • Projective Equipment
  • Tools
  • Equipment
  • Vehicles

• Action Taken

Hazard #3

• Name the Hazard

• Evaluate the Hazard; Pick 2.

  Select Imminent Danger Serious Minor Acceptable Not Applicable Probable Reasonably Probable Remote Extremely Remote

  • Imminent Danger
  • Serious
  • Minor
  • Acceptable
  • Not Applicable
  • Probable
  • Reasonably Probable
  • Remote
  • Extremely Remote

• Code of the Hazard

  Select Worksites Work Practices Projective Equipment Tools Equipment Vehicles

  • Worksites
  • Work Practices
  • Projective Equipment
  • Tools
  • Equipment
  • Vehicles

• Action Taken

Hazard #4

• Name the Hazard

• Evaluate the Hazard; Pick 2.

  Select Imminent Danger Serious Minor Acceptable Not Applicable Probable Reasonably Probable Remote Extremely Remote

  • Imminent Danger
  • Serious
  • Minor
  • Acceptable
  • Not Applicable
  • Probable
  • Reasonably Probable
  • Remote
  • Extremely Remote

• Code of the Hazard

  Select Worksites Work Practices Projective Equipment Tools Equipment Vehicles

  • Worksites
  • Work Practices
  • Projective Equipment
  • Tools
  • Equipment
  • Vehicles

• Action Taken

Hazard #5

• Name the Hazard

• Evaluate the Hazard; Pick 2.

  Select Imminent Danger Serious Minor Acceptable Not Applicable Probable Reasonably Probable Remote Extremely Remote

  • Imminent Danger
  • Serious
  • Minor
  • Acceptable
  • Not Applicable
  • Probable
  • Reasonably Probable
  • Remote
  • Extremely Remote

• Code of the Hazard

  Select Worksites Work Practices Projective Equipment Tools Equipment Vehicles

  • Worksites
  • Work Practices
  • Projective Equipment
  • Tools
  • Equipment
  • Vehicles

• Action Taken

Hazard #6

• Name the Hazard

• Evaluate the Hazard; Pick 2.

  Select Imminent Danger Serious Minor Acceptable Not Applicable Probable Reasonably Probable Remote Extremely Remote

  • Imminent Danger
  • Serious
  • Minor
  • Acceptable
  • Not Applicable
  • Probable
  • Reasonably Probable
  • Remote
  • Extremely Remote

• Code of the Hazard

  Select Worksites Work Practices Projective Equipment Tools Equipment Vehicles

  • Worksites
  • Work Practices
  • Projective Equipment
  • Tools
  • Equipment
  • Vehicles

• Action Taken

Hazard #7

• Name the Hazard

• Evaluate the Hazard; Pick 2.

  Select Imminent Danger Serious Minor Acceptable Not Applicable Probable Reasonably Probable Remote Extremely Remote

  • Imminent Danger
  • Serious
  • Minor
  • Acceptable
  • Not Applicable
  • Probable
  • Reasonably Probable
  • Remote
  • Extremely Remote

• Code of the Hazard

  Select Worksites Work Practices Projective Equipment Tools Equipment Vehicles

  • Worksites
  • Work Practices
  • Projective Equipment
  • Tools
  • Equipment
  • Vehicles

• Action Taken

• Conduct by

  Sign

• Reviewed by

  Sign