Information

  • Audit Title

  • Document No.

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

**** Report is to be considered an uncontrolled and/or unverified document if there is no original signature next to the electronic versions. ****

Stop, Step Back, Observe

  • Has a Risk assessment (JSA) been completed for the site/task?

  • Have you got the correct PPE for the site/task?

  • Have you been inducted to this site?

  • If no, is there one available?

  • Are you going to be escorted?

  • Have you looked close, looked wide and looked above for hazards?

Walk-Through Tasks

  • Is the work area in good order?

  • Is access okay?

  • Are Safe Operating Procedures available for this task?

  • Do you understand the job/task requirements?

Identify Hazards

  • Assess the risk of being struck by vehicles or mobile plant (outside walkways = at risk)

  • Assess the risk of being or becoming isolated from others (> 50m = at risk)

  • Assess the risk of communicating with others if in trouble (language or no reception = at risk)

  • Assess the risk of manual handling activities (over 15kg = at risk)

  • Assess the risk of accessing and working at heights (at heights = at risk)

  • Assess the risk of accessing and working in confined spaces (confined space = at risk)

  • Assess the risk of plant/equipment fail due to poor maintenance, etc (damaged = at risk)

  • Are identified risks covered by the JSA?

  • Have you the means to control these additional hazards?<br>Detail hazards and controls.

Access and Control Risk

  • Is risk assessment available?

  • What is the level of risk?<br>(If high or extreme - perform a full risk assessment)<br>

  • Are Hazard(s) removed or controlled?<br>(Provide details)

  • Have potential problems been discussed/resolved?

Safely Complete Task

  • Can this job/task continue safely?

Sign off

  • Sign off as confirmation of understanding

  • Person:
  • Name, Company, Position & Sign

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.