Safety Theme Inspection

• Document No.

• Safety Theme Inspection

• Area Inspected

• Area Supervisor

• Inspected by

• Role

  Supervisor

  General Foreman

  Superintendent

  Dept. Manager

  General Manager

• Conducted on

  Date

Safety Theme

• Safety Theme

• Condition Observed

Condition

• Enter details of condition

• Hazard Class

  A - 15 to 18 Extreme Risk (immediate action)

  B - 11 to 14 High Risk (within 3 days)

  C - 7 to 10 Medium Risk (within 7 days)

  D - 3 to 6 Low Risk (within 31 days)

• Action required

• Responsible Person

General

• Housekeeping

  OK

  Not OK

• Hazard Class

  A - 15 to 18 Extreme Risk (immediate action)

  B - 11 to 14 High Risk (within 3 days)

  C - 7 to 10 Medium Risk (within 7 days)

  D - 3 to 6 Low Risk (within 31 days)

• Action required

• Responsible Person

• Travel way / Roadways

  OK

  Not OK

• Hazard Class

  A - 15 to 18 Extreme Risk (immediate action)

  B - 11 to 14 High Risk (within 3 days)

  C - 7 to 10 Medium Risk (within 7 days)

  D - 3 to 6 Low Risk (within 31 days)

• Action required

• Responsible Person

• Lighting

  OK

  Not OK

• Hazard Class

  A - 15 to 18 Extreme Risk (immediate action)

  B - 11 to 14 High Risk (within 3 days)

  C - 7 to 10 Medium Risk (within 7 days)

  D - 3 to 6 Low Risk (within 31 days)

• Action required

• Responsible Person

• Stairs / Ladders / Platforms

  OK

  Not OK

• Hazard Class

  A - 15 to 18 Extreme Risk (immediate action)

  B - 11 to 14 High Risk (within 3 days)

  C - 7 to 10 Medium Risk (within 7 days)

  D - 3 to 6 Low Risk (within 31 days)

• Action required

• Responsible Person

• Exits - Access and Signage

  OK

  Not OK

• Hazard Class

  A - 15 to 18 Extreme Risk (immediate action)

  B - 11 to 14 High Risk (within 3 days)

  C - 7 to 10 Medium Risk (within 7 days)

  D - 3 to 6 Low Risk (within 31 days)

• Action required

• Responsible Person

Golden Rules

• Fit for Work

  OK

  Not OK

• Hazard Class

  A - 15 to 18 Extreme Risk (immediate action)

  B - 11 to 14 High Risk (within 3 days)

  C - 7 to 10 Medium Risk (within 7 days)

  D - 3 to 6 Low Risk (within 31 days)

• Action required

• Responsible Person

• Driving

  OK

  Not OK

• Hazard Class

  A - 15 to 18 Extreme Risk (immediate action)

  B - 11 to 14 High Risk (within 3 days)

  C - 7 to 10 Medium Risk (within 7 days)

  D - 3 to 6 Low Risk (within 31 days)

• Action required

• Responsible Person

• Ground Stability

  OK

  Not OK

• Hazard Class

  A - 15 to 18 Extreme Risk (immediate action)

  B - 11 to 14 High Risk (within 3 days)

  C - 7 to 10 Medium Risk (within 7 days)

  D - 3 to 6 Low Risk (within 31 days)

• Action required

• Responsible Person

• Lifting, Rigging, and Hoisting

  OK

  Not OK

• Hazard Class

  A - 15 to 18 Extreme Risk (immediate action)

  B - 11 to 14 High Risk (within 3 days)

  C - 7 to 10 Medium Risk (within 7 days)

  D - 3 to 6 Low Risk (within 31 days)

• Action required

• Responsible Person

• Energy Isolation

  OK

  Not OK

• Hazard Class

  A - 15 to 18 Extreme Risk (immediate action)

  B - 11 to 14 High Risk (within 3 days)

  C - 7 to 10 Medium Risk (within 7 days)

  D - 3 to 6 Low Risk (within 31 days)

• Action required

• Responsible Person

• Working at Heights

  OK

  Not OK

• Hazard Class

  A - 15 to 18 Extreme Risk (immediate action)

  B - 11 to 14 High Risk (within 3 days)

  C - 7 to 10 Medium Risk (within 7 days)

  D - 3 to 6 Low Risk (within 31 days)

• Action required

• Responsible Person

• Hazardous Substances

  OK

  Not OK

• Hazard Class

  A - 15 to 18 Extreme Risk (immediate action)

  B - 11 to 14 High Risk (within 3 days)

  C - 7 to 10 Medium Risk (within 7 days)

  D - 3 to 6 Low Risk (within 31 days)

• Action required

• Responsible Person

• Permit to Work

  OK

  Not OK

• Hazard Class

  A - 15 to 18 Extreme Risk (immediate action)

  B - 11 to 14 High Risk (within 3 days)

  C - 7 to 10 Medium Risk (within 7 days)

  D - 3 to 6 Low Risk (within 31 days)

• Action required

• Responsible Person

• Protective Devices & Guarding

  OK

  Not OK

• Hazard Class

  A - 15 to 18 Extreme Risk (immediate action)

  B - 11 to 14 High Risk (within 3 days)

  C - 7 to 10 Medium Risk (within 7 days)

  D - 3 to 6 Low Risk (within 31 days)

• Action required

• Responsible Person

• Personal Protective Equipment

  OK

  Not OK

• Hazard Class

  A - 15 to 18 Extreme Risk (immediate action)

  B - 11 to 14 High Risk (within 3 days)

  C - 7 to 10 Medium Risk (within 7 days)

  D - 3 to 6 Low Risk (within 31 days)

• Action required

• Responsible Person

Comments

• Enter comments

Review / Sign Off

• Supervisor

  Sign

• Exploration Manager

  Sign