Information
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Audit Title
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Document No.
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
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Area
Reaction of People
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Adjusting PPE
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Changing Position
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Rearranging Job
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Stopping Job
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Attaching Grounds
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Performing Locks
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Comments
Personal Protective Equipment and Quality Protective Equipment
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Gown
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Gloves
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Safety Glasses
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Face Mask
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Apron
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Comments
Positions of People
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Striking against or struck by objects
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Caught in, on, or between objects
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Falling
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Contacting Extreme Temperatures
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Contacting electrical current
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Inhaling, absorbing, or swallowing a hazardous substance
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Repetitive Motions
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Awkward positions, static postures
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Comments
Tools
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Right for the job
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Used Correctly
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In good condition
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Comments
Procedures
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Available
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Adequate
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Known
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Understood
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Followed
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Comments
Orderliness
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Known Order
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Understood order
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Followed Order
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Comments
Observation Report
Safe Acts
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What safe acts were observed?
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What actions were taken to encourage safe performance
Unsafe Acts
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What unsafe acts were observed?
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What corrective action was taken?
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What action was taken to prevent further occurance?