Audit
Observer Name:
Employee's Dept.:
Employee's Type:
site:
Location:
Observation Condition:
NORMAL
SHUTDOWN
BREAKDOWN
Has the employee been observed by someone else this month?:
TASK DESCRIPTION:
Can you tell me about your task:
What are the main hazards/risks associated with this task?
what controls do you have in place and do you think they are enough?
What are the controls do you have in place and do you think they are enough?
What are the current health and safety issues your department experiencing?
How are these issues/concerns being addressed?
On this job, do you feel there may be a need to deviate from standard procedure?
BODY POSITION
Line of Fire
quick notes:
Eyes on Path
quick notes:
Ascending / Descending
quick notes:
Pinch Points/ Rotating Objects
quick notes:
MANUAL/ HANDLING ERGONOMICS
Lifting/ Lowering
quick notes:
Twisting
quick notes:
Pushing / Pulling
quick notes:
Posture ? Overextended / Cramped
quick notes:
Response to Ergonomics Risk
quick notes:
TOOLS AND EQUIPMENT
Tool/Equipment Selection
quick notes:
Tool/Equipment Condition
quick notes:
Guarding/Barricades/Delineation
quick notes:
PROCEDURES:
Take 5/JHA/Project
quick notes:
Isolation / Tag- out
quick notes:
Communication of a Hazards
quick notes:
Permits
quick notes:
Light Vehicle Operations
quick notes:
Surface Mobile Equipment
quick notes:
Lifting Equipment
quick notes:
Explosives
quick notes:
Work at Height
quick notes:
Confined Space Entry
quick notes:
WORK ENVIRONMENT
Walking / Working Surfaces
quick notes:
Housekeeping/ Storage
quick notes:
Lighting
quick notes:
Temperature Extremes / UVR Exposure
quick notes:
Liquid Transfer / Uncontrolled Discharge
quick notes:
Hazardous Materials/ Noise Dust
quick notes:
PPE
Basic PPE
quick notes:
Task Specific PPE
quick notes:
Fatigue Management
quick notes:
Check training and attach for every 10th interaction conducted.
quick notes:
POSITIVE FEEDBACK NOTES
What WAS the at-risk behavior observed?
2.
3.
Was the employee AWARE of the at-risk behavior?
2.
3.
Does the employee AGREE that it is/was at-risk?
2.
3.
What is the employee's REASON behind working at-risk?
2.
3.
What is the agreed on suggestion for a SOLUTION?
2.
3.
immediate Actions:
Completed:
Corrective Actions:
Responsible Person:
Due date:
