Title Page
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Site
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Conducted on
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Prepared by
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Shift
Safety Checklist
Safety Checks
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All scoring questions use the Number response type:
0 = Fail, 1 = Needs Attention, 2 = Pass -
Scaffolding is properly secured
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Fall protection is used
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Electrical hazards are addressed
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Walkways are clear of debris
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PPE compliance observed
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Equipment is maintained
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First aid kit is accessible
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Safety signage is visible
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Compliance Score (%)
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Risk Factor Score
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This penalizes lower average scores exponentially, resulting in a higher risk score for non-compliance.
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Compliance Variation
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Measures inconsistency across safety checkpoints.
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Consistency Score
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A lower average deviation increases the consistency score, which reflects operational discipline.
Evidence & Corrective Actions
- Supporting Evidence
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Upload Photos of Issues
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Notes or Observations
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Area of Concern
Action Items
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Were any issues found? If yes, create a corrective action.
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Inspector signature
Approval
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Date and time of approval
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Approver's signature