Information
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Document No.
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SAFETY VISIT
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Site
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Conducted on
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Location
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Personnel conducting safety visit
What is the task being performed and location
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Add media
Number of personnel observed
Personnel employed by
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Heathgate
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Contractor
IMPROVEMENT OPPORTUNITIES
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Category
- Permits and other documents
- Standards & procedures
- Position of people/mobile equipment
- Ergonomics
- Tools and equipment
- Housekeeping/area conditions
- PPE
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Potential consequence severity
- (Insignificant) observation/first aid/minor injury/low level short term environmental impact
- (Low) Medical referral/minor environmental impact
- (Moderate) Lost time injury/moderate environmental impact
- (High) Fatality/serious environmental impact
- (Critical) Multiple fatalities/serious long term environmental impact
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Description
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Add media
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Actions taken
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Further actions to be taken by whom and by when.
IMPROVEMENT OPPORTUNITIES
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Category
- Permits and other documents
- Standards & procedures
- Position of people/mobile equipment
- Ergonomics
- Tools and equipment
- Housekeeping/area conditions
- PPE
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Potential consequence severity
- (Insignificant) observation/first aid/minor injury/low level short term environmental impact
- (Low) Medical referral/minor environmental impact
- (Moderate) Lost time injury/moderate environmental impact
- (High) Fatality/serious environmental impact
- (Critical) Multiple fatalities/serious long term environmental impact
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Description
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Add media
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Actions taken
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Further actions to be taken by whom and by when.
IMPROVEMENT OPPORTUNITIES
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Category
- Permits and other documents
- Standards & procedures
- Position of people/mobile equipment
- Ergonomics
- Tools and equipment
- Housekeeping/area conditions
- PPE
-
Potential consequence severity
- (Insignificant) observation/first aid/minor injury/low level short term environmental impact
- (Low) Medical referral/minor environmental impact
- (Moderate) Lost time injury/moderate environmental impact
- (High) Fatality/serious environmental impact
- (Critical) Multiple fatalities/serious long term environmental impact
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Description
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Add media
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Actions taken
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Further actions to be taken by whom and by when.
IMPROVEMENT OPPORTUNITIES
-
Category
- Permits and other documents
- Standards & procedures
- Position of people/mobile equipment
- Ergonomics
- Tools and equipment
- Housekeeping/area conditions
- PPE
-
Potential consequence severity
- (Insignificant) observation/first aid/minor injury/low level short term environmental impact
- (Low) Medical referral/minor environmental impact
- (Moderate) Lost time injury/moderate environmental impact
- (High) Fatality/serious environmental impact
- (Critical) Multiple fatalities/serious long term environmental impact
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Description
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Add media
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Actions taken
-
Further actions to be taken by whom and by when.
IMPROVEMENT OPPORTUNITIES
-
Category
- Permits and other documents
- Standards & procedures
- Position of people/mobile equipment
- Ergonomics
- Tools and equipment
- Housekeeping/area conditions
- PPE
-
Potential consequence severity
- (Insignificant) observation/first aid/minor injury/low level short term environmental impact
- (Low) Medical referral/minor environmental impact
- (Moderate) Lost time injury/moderate environmental impact
- (High) Fatality/serious environmental impact
- (Critical) Multiple fatalities/serious long term environmental impact
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Description
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Add media
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Actions taken
-
Further actions to be taken by whom and by when.
IMPROVEMENT OPPORTUNITIES
-
Category
- Permits and other documents
- Standards & procedures
- Position of people/mobile equipment
- Ergonomics
- Tools and equipment
- Housekeeping/area conditions
- PPE
-
Potential consequence severity
- (Insignificant) observation/first aid/minor injury/low level short term environmental impact
- (Low) Medical referral/minor environmental impact
- (Moderate) Lost time injury/moderate environmental impact
- (High) Fatality/serious environmental impact
- (Critical) Multiple fatalities/serious long term environmental impact
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Description
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Add media
-
Actions taken
-
Further actions to be taken by whom and by when.
IMPROVEMENT OPPORTUNITIES
-
Category
- Permits and other documents
- Standards & procedures
- Position of people/mobile equipment
- Ergonomics
- Tools and equipment
- Housekeeping/area conditions
- PPE
-
Potential consequence severity
- (Insignificant) observation/first aid/minor injury/low level short term environmental impact
- (Low) Medical referral/minor environmental impact
- (Moderate) Lost time injury/moderate environmental impact
- (High) Fatality/serious environmental impact
- (Critical) Multiple fatalities/serious long term environmental impact
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Description
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Add media
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Actions taken
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Further actions to be taken by whom and by when.
Observed safe behaviour
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Category
- Permits and other documents
- Standards & procedures
- Position of people/mobile equipment
- Ergonomics
- Tools and equipment
- Housekeeping/area conditions
- PPE
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Description
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Add media
Observed safe behaviour
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Category
- Permits and other documents
- Standards & procedures
- Position of people/mobile equipment
- Ergonomics
- Tools and equipment
- Housekeeping/area conditions
- PPE
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Description
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Add media
Observed safe behaviour
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Category
- Permits and other documents
- Standards & procedures
- Position of people/mobile equipment
- Ergonomics
- Tools and equipment
- Housekeeping/area conditions
- PPE
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Description
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Add media
Observed safe behaviour
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Category
- Permits and other documents
- Standards & procedures
- Position of people/mobile equipment
- Ergonomics
- Tools and equipment
- Housekeeping/area conditions
- PPE
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Description
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Add media
Observed safe behaviour
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Category
- Permits and other documents
- Standards & procedures
- Position of people/mobile equipment
- Ergonomics
- Tools and equipment
- Housekeeping/area conditions
- PPE
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Description
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Add media
Observed safe behaviour
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Category
- Permits and other documents
- Standards & procedures
- Position of people/mobile equipment
- Ergonomics
- Tools and equipment
- Housekeeping/area conditions
- PPE
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Description
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Add media
Observed safe behaviour
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Category
- Permits and other documents
- Standards & procedures
- Position of people/mobile equipment
- Ergonomics
- Tools and equipment
- Housekeeping/area conditions
- PPE
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Description
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Add media
Hazards observed
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Category
- Permits and other documents
- Standards & procedures
- Position of people/mobile equipment
- Ergonomics
- Tools and equipment
- Housekeeping/area conditions
- PPE
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Description of hazard
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Add media
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Action to be taken
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Auditor
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Action to be taken by whom and by when
Hazards observed
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Category
- Permits and other documents
- Standards & procedures
- Position of people/mobile equipment
- Ergonomics
- Tools and equipment
- Housekeeping/area conditions
- PPE
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Description of hazard
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Add media
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Action to be taken
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Action to be taken by whom and by when
Hazards observed
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Category
- Permits and other documents
- Standards & procedures
- Position of people/mobile equipment
- Ergonomics
- Tools and equipment
- Housekeeping/area conditions
- PPE
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Description of hazard
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Add media
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Action to be taken
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Action to be taken by whom and by when
Hazards observed
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Category
- Permits and other documents
- Standards & procedures
- Position of people/mobile equipment
- Ergonomics
- Tools and equipment
- Housekeeping/area conditions
- PPE
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Description of hazard
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Add media
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Action to be taken
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Action to be taken by whom and by when
Signature/s
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Auditor
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Auditor
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Auditor
