Site Safety Observation Record Version 2

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

PPE

• Head

  Yes

  No

  N/A

• Eye / Face

  Yes

  No

  N/A

• Hearing

  Yes

  No

  N/A

• Respiratory

  Yes

  No

  N/A

• Hand

  Yes

  No

  N/A

• Body

  Yes

  No

  N/A

• Feet

  Yes

  No

  N/A

Procedure

• JSA / SWMS

  Yes

  No

  N/A

• Pre-start Checks

  Yes

  No

  N/A

• Tag / Test / Lock

  Yes

  No

  N/A

• Job Preparation

  Yes

  No

  N/A

• Chemical Use (MSDS)

  Yes

  No

  N/A

Working Environment

• Housekeeping

  Yes

  No

  N/A

• Barricading

  Yes

  No

  N/A

• Thermal Comfort

  Yes

  No

  N/A

• Storage

  Yes

  No

  N/A

• Facility / Site Condition

  Yes

  No

  N/A

• Working Conditions

  Yes

  No

  N/A

Tools / Equipment

• Appropriate Selection

  Yes

  No

  N/A

• Condition

  Yes

  No

  N/A

• Correct Use

  Yes

  No

  N/A

• Current Tags - Electrical

  Yes

  No

  N/A

• Current Tags - Scaffolding

  Yes

  No

  N/A

• Current Tags - Rigging

  Yes

  No

  N/A

Body Use / Position

• Line of Fire

  Yes

  No

  N/A

• Lifting

  Yes

  No

  N/A

• Pushing / Pulling

  Yes

  No

  N/A

• Carrying

  Yes

  No

  N/A

• Walking

  Yes

  No

  N/A

• Climbing

  Yes

  No

  N/A

• Posture

  Yes

  No

  N/A

Mobile Equipment

• Condition

  Yes

  No

  N/A

• Use / Operation

  Yes

  No

  N/A

• Entry / Exit

  Yes

  No

  N/A

Commendable Safe Behavious Observed

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• On site representative

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• Auditor's signature

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