SAFETY OBSERVATION REPORT

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Jobsite Name

• Select date

  Date

• Observer

• Area Observered

OBSERVATIONS

• Is Job Safety Analysis present?

  Yes

  No

  N/A

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  Media

• Task is known and understood by employee?

  Safe

  At Risk

  N/A

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  Media

• Policies and procedures are being followed?

  Safe

  At Risk

  N/A

• Add media

  Media

• Employees are trained and authorized to do work being performed?

  Safe

  At Risk

  N/A

• Add media

  Media

• Correct tools are being used?

  Safe

  At Risk

  N/A

• Add media

  Media

• Appropriate PPE is being worn?

  Safe

  At Risk

  N/A

• Add media

  Media

• All hazards are being controlled properly?

  Safe

  At Risk

  N/A

• Add media

  Media

• Work area is clean and free of hazards?

  Safe

  At Risk

  N/A

• Add media

  Media

Additional Observations made:

Completed by:

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Safety Coordinator / Reviewer:

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