Title Page
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Name of group person(s):
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Business Unit:
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Site:
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Date on site:
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Date off site:
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On Site Contact Person(s):
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Date of last visit:
Visit Scope
Scope of Visit:
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What is the general scope of the visit?
Agenda Items:
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What are the agenda items?
Objectives:
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What are the specific measurable objectives of the visit?
Opening Meeting
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Meeting Attendees:
Executive Summary
Introduction
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The Safety Inspection
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Inspection summary:
Top 6 Hazards on Site
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1) Type of Hazard
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Detail:
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2) Type of Hazard
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Detail:
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3) Type of Hazard
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Detail:
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4) Type of Hazard
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Detail:
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5) Type of Hazard
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Detail:
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6) Type of Hazard
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Detail:
Site Hazards
- Buildings/Structures
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Description & Photo of hazard
Chemicals
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Description & Photo of hazard
Defective Machinery/Equipment
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Description & Photo of hazard
Defective Tools/Equipment
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Description & Photo of hazard
Electrical
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Description & Photo of hazard
Falling from height
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Description & Photo of hazard
Falling Materials
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Description & Photo of hazard
Machinery Guarding
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Description & Photo of hazard
Heat/Flame/Fire/Smoke
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Description & Photo of hazard
Housekeeping (Lack of 5s management)
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Description & Photo of hazard
Improperly Secured Loads
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Description & Photo of hazard
Lockout/Tagout (Energy isolation)
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Description & Photo of hazard
Manual Handling
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Description & Photo of hazard
Other
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Description & Photo of hazard
PPE (Not available or being worn)
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Description & Photo of hazard
Slips/Trips/Falls
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Description & Photo of hazard
Unsafe Work Practices
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Description & Photo of hazard
Working Surfaces (Damaged roadways/ uneven floor surfaces/ Damaged working platforms)
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Description & Photo of hazard
Workplace Transport (Vehicles, roadways, driver & pedestrian safety)
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Description & Photo of hazard
Close Out
Closing Meeting
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Meeting Attendees:
Further Notes/Comments
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Notes:
Reference Documents
- Reference/Guidance Type
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Guidance doc. type or description (attach media)
