Safety Interaction

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Safety Interaction

• Observer Name:

• Select date

  Date

• Employee's Department:

• Employee Type:

• Site:

• Location:

• Observation Condition:

  Normal

  Shutdown

  Breakdown

• Has the employee been observed by someone else this month?

  Yes

  No

  N/A

• Task Description:

Questions for the Employee

• 1. Can you tell me about your task?

• 2. What are the main hazards / risks associated with this task?

• 3. What controls do you have in place and do you think they are enough?

• 4. What are the current health and safety issues your department is experiencing?

• 5. How are these issues / concerns being addressed?

• 6. On this job, do you feel there may be a need to deviate from standard procedure?

BODY POSITION

• Line of Fire

  Safe

  At Risk

  N/A

• Eyes on path

  Safe

  At Risk

  N/A

• Eyes on Task

  Safe

  At Risk

  N/A

• Ascending / Descending

  Safe

  At Risk

  N/A

• Pinch Points / Rotating Objects

  Safe

  At Risk

  N/A

MANUAL HANDLING /ERGONOMICS

• Lifting / Lowering

  Safe

  At Risk

  N/A

• Twisting

  Safe

  At Risk

  N/A

• Pushing / Pulling

  Safe

  At Risk

  N/A

• Posture / Overextended / Cramped

  Safe

  At Risk

  N/A

• Response to Ergonomic Risk

  Safe

  At Risk

  N/A

TOOLS & EQUIP.

• Tool/Equipment Selection

  Safe

  At Risk

  N/A

• Tool/Equipment Condition

  Safe

  At Risk

  N/A

• Tool/Equipment Use

  Safe

  At Risk

  N/A

• Guarding / Barricades / Delineation

  Safe

  At Risk

  N/A

PROCEDURES

• Take 5 / JHA / Prestart

  Safe

  At Risk

  N/A

• Isolation / Tag-out

  Safe

  At Risk

  N/A

• Communication of Hazards

  Safe

  At Risk

  N/A

• Permits

  Safe

  At Risk

  N/A

• Light Vehicle Operations

  Safe

  At Risk

  N/A

• Surface Mobile Equipment

  Safe

  At Risk

  N/A

• Lifting Equipment

  Safe

  At Risk

  N/A

• Explosives

  Safe

  At Risk

  N/A

• Work at Height

  Safe

  At Risk

  N/A

• Confined Space Entry

  Safe

  At Risk

  N/A

WORK ENVIRONMENT

• Walking / Working Surfaces

  Safe

  At Risk

  N/A

• Housekeeping / Storage

  Safe

  At Risk

  N/A

• Lighting

  Safe

  At Risk

  N/A

• Temperature Extremes / UVR Exposure

  Safe

  At Risk

  N/A

• Liquid Transfer / Uncontrolled Discharge

  Safe

  At Risk

  N/A

• Hazardous Materials / Noise / Dust

  Safe

  At Risk

  N/A

PPE (Personal Protective Equipment)

• Basic PPE

  Safe

  At Risk

  N/A

• Task Specific PPE

  Safe

  At Risk

  N/A

Other

• Fatigue Management

  Safe

  At Risk

  N/A

• Check training record and attach for every 10th Interaction conducted

  Safe

  At Risk

  N/A

Positive Feedback Notes

What were the safe behaviours you observed and what did you like about them?

At-Risk Behaviour Notes

What WAS the at-risk behaviour observed?

• Was the employee AWARE of the at-risk behaviour?

  Yes

  No

  N/A

• Does the employee AGREE that it is/was at-risk?

  Yes

  No

  N/A

• What is the employee’s REASON behind working at-risk?

• What is an agreed on suggestion for a SOLUTION?

Action Notes

Immediate Actions

• Completed

• Corrective Actions

• Responsible Person

• Due Date

OFFICE USE ONLY

• Quality Score: