Safety Walk Form

• Safety Walk No

Details

• Observer EPF:

• Observer Full Name:

• Business Details (Select one)

  New Installation

  Service/ Maintenance

  Repair

  Modernization
• Site Address:
  Address

• Date

  Date

• Contract Number

Employee Details

• Employee Type

  TPL Employee

  Sub Con Employee

• Employee Name

• EPF/ SCID

Feedbacks

• Positive Feedback/s

  Select

• Corrective Feedback - Unsafe Acts

  Select Operate without following adequate procedure Lack or improper use of PPE Unsafe hoist way access procedure Fall protection is not in place Improper lifting & sling Failure to follow proper LOTO procedure Improper jumper procedure Failure to inform about unsafe situation Bypass or removal of safety devices Improper material handling practices Using defective equipment

  • Operate without following adequate procedure
  • Lack or improper use of PPE
  • Unsafe hoist way access procedure
  • Fall protection is not in place
  • Improper lifting & sling
  • Failure to follow proper LOTO procedure
  • Improper jumper procedure
  • Failure to inform about unsafe situation
  • Bypass or removal of safety devices
  • Improper material handling practices
  • Using defective equipment

• Corrective Feedback - Unsafe Condition

  Select

Hazard Identification

• Overall hazard/ risk identified by technician

  Select

Knowledge on Safety Topics

• Safety Golden Rules

  Select

• SAFE Rules

  Select

Rating

• Overall evaluation of Technician behaviour: (Select one)

  Select

Action #1

• Title:

• Initial Due Date:

  Date

• Assign To:

• Description:

Action #2

• Title:

• Initial Due Date:

  Date

• Assign To:

• Description:

Action #3

• Title:

• Initial Due Date:

  Date

• Assign To:

• Description:

Action #4

• Title:

• Initial Due Date:

  Date

• Assign To:

• Description:

Action #5

• Title:

• Initial Due Date:

  Date

• Assign To:

• Description:

Signature

• Signature

  Sign