Title Page

  • Date and Time

  • Site conducted

  • SMAT Leader

  • SMAT Receiver

  • Who is the SMAT receiver?

  • Employee Type

  • Department

  • What area is the receiver working?

  • What area?

  • What area is the receiver working?

  • What area?

  • What area is the receiver working?

  • What area?

  • What area is the receiver working?

  • What area?

  • What area is the receiver working?

  • Describe Task Performed

  • Is this task routine or non-routine?

  • How frequently do they do this task?

Checklist

Observations

  • Procedures and Pre-Job Inspection

  • Why is this a concern?

  • Environment (5S, Exposure, Temp)

  • Why is this a concern?

  • Use of PPE

  • Why is this a concern?

  • Ergonomics and Manual Handling

  • Why is this a concern?

  • Pace

  • Why is this a concern?

  • Tools and Equipment

  • Why is this a concern?

  • Electrical hazards

  • Is the electrical equipment tested and tagged?

  • Is the equipment secured/locked/isolated?

  • Is there any visible damage or exposed wires?

  • Can you identify a high gravity risk?

  • Describe the high gravity risk?

  • Can you identify a high frequency risk?

  • Describe the high frequency risk?

Completion

  • SMAT Leader Additional Actions & Comments

  • SMAT Receiver Comments & Improvement Suggestions

  • Signature

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.