Site Safety Observation Record

• Document No.

• Audit Title

• Crew / Site

• Personnel observed

• Location
  Address

• Conducted on

  Date

• Prepared by

Observed Safety Hazards & Risks Categories (tick where applicable)

• PROCEDURE

  Select Selection Condition Use Current Tags - Electrical Current Tags - Scaffolding Current Tags - Rigging

  • Selection
  • Condition
  • Use
  • Current Tags - Electrical
  • Current Tags - Scaffolding
  • Current Tags - Rigging

• Is Action Required

  Safe

  At Risk

  N/A

• PPE

  Select Head Eyes Face Hearing Respiratory Hand Hand Body Feet

  • Head
  • Eyes
  • Face
  • Hearing
  • Respiratory
  • Hand
  • Hand
  • Body
  • Feet

• Is Action Required

  Safe

  At Risk

  N/A

• WORK ENVIRONMENT

  Select Housekeeping Barricading Exclusion Zones Thermal Control Storage Facility Conditions Working Conditions Confined Space

  • Housekeeping
  • Barricading
  • Exclusion Zones
  • Thermal Control
  • Storage
  • Facility Conditions
  • Working Conditions
  • Confined Space

• Is Action Required

  Safe

  At Risk

  N/A

• TOOLS / EQUIPMENT

  Select Selection Condition Use Current Tags - Electrical Current Tags - Scaffolding Current Tags - Rigging

  • Selection
  • Condition
  • Use
  • Current Tags - Electrical
  • Current Tags - Scaffolding
  • Current Tags - Rigging

• Is Action Required

  Safe

  At Risk

  N/A

• BODY USE / POSITION

  Select Line of Fire Lifting Pushing / Pulling Carrying Walking Climbing Posture

  • Line of Fire
  • Lifting
  • Pushing / Pulling
  • Carrying
  • Walking
  • Climbing
  • Posture

• Is Action Required

  Safe

  At Risk

  N/A

• MOBILE EQUIPMENT

  Select Condition Use Enter / Exit Pedestrian Segregation

  • Condition
  • Use
  • Enter / Exit
  • Pedestrian Segregation

• Is Action Required

  Yes

  No

  N/A

Hazard / Risk observed not previously defined

Hazard / Risk Identified

• Hazard / Risk

  Safe

  At Risk

  N/A

Commendable Safe Behaviour Observed

Safety Inspection Completion Sign Off

• The Officer completing this Safety Observation must ensure that the final report is sent through to Safety Services for recording of Hazards and required follow up Actions.
  
  

• Observation Completed by

  Sign

• The Site Representative accepts the findings of this Safety Observation and if required shall ensure that any corrective actions indentified during this Observation shall be actioned immediately.

• Site Representative (if relevant)

  Sign