• Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • 1. Safe Practices Observed:

  • Positive Feedback:

  • Substandard Acts Observed:

  • Corrective Actions:

  • Any non-behavioural issues identified should be entered into the Sandvik Incident Report System

  • Incident Report No:

  • Observer Signature:

Sub Standard Observations

Standards, Procedures, Work Instructions, JRA:

  • Nothing in place

  • Person unaware

  • Not followed

  • Document No's:

Personal Protective Equipment / Clothing:

  • Wrong type / Inappropriate for job

  • Not used correctly

  • All requirements no been identified

Tools / Equipment used for task:

  • Wrong type / inappropriate for job

  • Not used correctly

  • Damaged / Unserviceable

Exposure to Injure mechanism:

  • Striking against something

  • Struck by something

  • Trapped in, on or between moving parts

  • Falling

  • Strain / Over-exertion

  • Constant repetitive actions

  • Contact extreme hot or cold

  • Contact with electrical current

  • Exposed to hazardous substances


  • Area not assessed for suitability before start

  • Area not kept tidy during the task

  • Area not left tidy after task completed <br>

Isolation / Pre start:

  • All isolation points not identified

  • Isolation not performed correctly

  • Pre starts not preformed as required

  • Other:

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.