Sandvik Safety Observation Report

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• 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:

  Sign

Sub Standard Observations

Standards, Procedures, Work Instructions, JRA:

• Nothing in place

  Yes

  No

  N/A

• Person unaware

  Yes

  No

  N/A

• Not followed

  Yes

  No

  N/A

• Document No's:

Personal Protective Equipment / Clothing:

• Wrong type / Inappropriate for job

  Yes

  No

  N/A

• Not used correctly

  Yes

  No

  N/A

• All requirements no been identified

  Yes

  No

  N/A

Tools / Equipment used for task:

• Wrong type / inappropriate for job

  Yes

  No

  N/A

• Not used correctly

  Yes

  No

  N/A

• Damaged / Unserviceable

  Safe

  At Risk

  N/A

Exposure to Injure mechanism:

• Striking against something

  Yes

  No

  N/A

• Struck by something

  Yes

  No

  N/A

• Trapped in, on or between moving parts

  Yes

  No

  N/A

• Falling

  Yes

  No

  N/A

• Strain / Over-exertion

  Yes

  No

  N/A

• Constant repetitive actions

  Yes

  No

  N/A

• Contact extreme hot or cold

  Yes

  No

  N/A

• Contact with electrical current

  Yes

  No

  N/A

• Exposed to hazardous substances

  Yes

  No

  N/A

Housekeeping:

• Area not assessed for suitability before start

  Yes

  No

  N/A

• Area not kept tidy during the task

  Yes

  No

  N/A

• Area not left tidy after task completed <br>

  Yes

  No

  N/A

Isolation / Pre start:

• All isolation points not identified

  Yes

  No

  N/A

• Isolation not performed correctly

  Yes

  No

  N/A

• Pre starts not preformed as required

  Yes

  No

  N/A

• Other: