• Audit Title

  • Document No.

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • Area

Reaction of People

  • Adjusting PPE

  • Changing Position

  • Rearranging Job

  • Stopping Job

  • Attaching Grounds

  • Performing Locks

  • Comments

Personal Protective Equipment and Quality Protective Equipment

  • Gown

  • Gloves

  • Safety Glasses

  • Face Mask

  • Apron

  • Comments

Positions of People

  • Striking against or struck by objects

  • Caught in, on, or between objects

  • Falling

  • Contacting Extreme Temperatures

  • Contacting electrical current

  • Inhaling, absorbing, or swallowing a hazardous substance

  • Repetitive Motions

  • Awkward positions, static postures

  • Comments


  • Right for the job

  • Used Correctly

  • In good condition

  • Comments


  • Available

  • Adequate

  • Known

  • Understood

  • Followed

  • Comments


  • Known Order

  • Understood order

  • Followed Order

  • Comments

Observation Report

Safe Acts

  • What safe acts were observed?

  • What actions were taken to encourage safe performance

Unsafe Acts

  • What unsafe acts were observed?

  • What corrective action was taken?

  • What action was taken to prevent further occurance?

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.