SENIOR MANAGEMENT SAFETY INSPECTION

• Conducted on

  Date

• Prepared by

• Location
  Address

• Risk Assessment Document Available

  Compliant

  Non-Compliant

  N/A

• Hazards Identification and Rating System

  Compliant

  Non-Compliant

  N/A

• Risk Response Mitigation and Controls

  Compliant

  Non-Compliant

  N/A

• Checklist Document Available

  Yes

  No

  N/A

• Has the Last Inspection been Reviewed?

  Yes

  No

  N/A

• Are there No Outstanding Actions?

  Yes

  No

  N/A

• Are Safety Talk Conducted

  Yes

  No

  N/A

• Name of Work Team/Group in Attendance

  Compliant

  Non-Compliant

  N/A

• Meeting Topic and Meeting Discussion Point

  Select Elimination Substitution Engineering Control Administration Personnel Protective Equipment Others

  • Elimination
  • Substitution
  • Engineering Control
  • Administration
  • Personnel Protective Equipment
  • Others

• Elimination

• Substitution

• Engineering Control

• Administration

• Personnel Protective Equipment

• Others

• Explanation of control Measures

• Recommendation from OHSE

SITE CHECK INSPECTION

• Finding 1

  Compliant

  Non-Compliant

  N/A

• Finding 2

  Compliant

  Non-Compliant

  N/A

• Finding 3

  Compliant

  Non-Compliant

  N/A

• Finding 4

  Compliant

  Non-Compliant

  N/A

• Finding 5

  Compliant

  Non-Compliant

  N/A

ATTENDANCE SIGN

• Name 1

  Sign

• Name 2

  Sign

• Guest

  Sign

• Safety

  Sign