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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Time of the safety conversation
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THIS FORM WORKS BETTER IN LANDSCAPE MODE!!!
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What is the job/role of the person you had a safety conversation with?
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Describe a scenario that could potentially seriously injure or kill someone around here?
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Add a photo of the site if you wish...
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What type of damaging energy is the major contributor to this potential scenario?
- Human (physical or muscular exertion)
- Gravitational (falling)
- Vehicular
- Contact with moving object
- Machinery
- Electrical contact
- Thermal (extreme hot/cold or fire)
- Chemical (liquid/gas/other)
- Radiation (manufactured or natural sun)
- Noise
- Water pressure
- Flooding
- Explosive
- Structural collapse
- Biological
- Animal
- Eyes
- Contact with sharp object
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How often, in your experience, have you heard of this scenario actually happening and seriously injuring or killing someone?
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Where have you heard of this scenario actually happening?
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What are the main controls in place here that reduce the risk of this scenario actually occurring?
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What "hierarchy of control"measure is being relied on most here?
- Elimination
- substitution
- isolation
- engineering controls
- administrative controls (instructions and signs)
- PPE
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Are the controls effective? If not, describe how they might be improved?
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If there are any other safety issues concerning you or your team, please note the main points below...
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Did you spot any safety hazards at this site?
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Please click the "sign here" button at right and initial.
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NOW EMAIL THE SAFETY CONVERSATION BY:
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Clicking "Options" in the top right hand corner of your screen
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Clicking "Preview"
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Clicking "Send" then enter the email address SC@sunwater.com.au
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Clicking "Send" then "Close
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Clicking the "DONE" button
