Safety Observation Program

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Housekeeping / 6 S

• Work and storage areas are clean and tidy.

  Yes

  No

  N/A

• Work stations are well organized and no trip hazards are present.

  Yes

  No

  N/A

• Circulation paths are kept clear of any item.

  Yes

  No

  N/A

• Emergency equipment (eyewash, fire extinguishers) is constantly accessible.

  Yes

  No

  N/A

• Emergency routes and emergency doors are kept clear of any item and fully accessible. Emergency doors are not locked.

  Yes

  No

  N/A

• Equipments and tools (hoses, fittings, cones, etc.) are appropriately stored

  Yes

  No

  N/A

Safety signage

• Signs indicating required Personal Protective Equipments are in place.

  Yes

  No

  N/A

• Signs indicating eyewash/safety shower, emergency exits, fire extinguishers, etc. are in place.

  Yes

  No

  N/A

Personal Protective Equipment (PPE)

• Required PPE is donned and kept in good condition.

  Yes

  No

  N/A

Environment

• Sample buckets and drums are properly labeled

  Yes

  No

  N/A

Warnings , signs and barricades

• Hose transfers, toting, drumming, and maintenance activities are properly identified and protected.

  Yes

  No

  N/A

Maintenance

• Equipments (lighting fixtures, machine guarding, barriers, etc.) are maintained in good working condition and in place.

  Yes

  No

  N/A

Respiratory protection

• Respiratory protection is used as required.

  Yes

  No

  N/A

Other

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Accomplishments : select one or two items for which the employees or the site should be recommended :

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• undefined

Items at risk

• Yes

  No

  N/A

PRELIMINARY ACTION PLAN discussed during the inspection

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