Title Page

  • Conducted on

  • Prepared by

  • Location

RISK ASSESSMENT

  • Risk Assessment Document Available

  • Hazards Identification and Rating System

  • Risk Response Mitigation and Controls

CHECKLIST INSPECTION

  • Checklist Document Available

  • Has the Last Inspection been Reviewed?

  • Are there No Outstanding Actions?

COMMUNICATION

  • Are Safety Talk Conducted

  • Name of Work Team/Group in Attendance

  • Meeting Topic and Meeting Discussion Point

  • Elimination

  • Substitution

  • Engineering Control

  • Administration

  • Personnel Protective Equipment

  • Others

  • Explanation of control Measures

  • Recommendation from OHSE

SITE CHECK INSPECTION

  • Finding 1

  • Finding 2

  • Finding 3

  • Finding 4

  • Finding 5

ATTENDANCE SIGN

  • Name 1

  • Name 2

  • Guest

  • Safety

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