Information
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Taking The High Road To Safety!
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Interaction & Audit
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Site:
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Conducted on
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Prepared by
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Location
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Personnel Involved:
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Was the interaction Safe:
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Was the interaction Unsafe, if so check appropriate box below.
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Other
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Line-of-Fire
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At Risk Behavior
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Rushing/Short Cuts
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Fatigue
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Manual Handling
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Vehicle & Driving
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Cranes & Rigging
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Slip/Trip/Falls
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Housekeeping
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What did you observe the employee doing?
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Picture of Observation:
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Don't forget to ask; did the employee perform a self-observation?
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Was the Self-Observation completed?
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If not why?
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If so, what hazards/risk did they find and what did they do to mitigate the hazard/risk?
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Describe the interaction that you had with the employee:
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Was there a safer way to complete the job?
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Did the employee agree to make the changes?
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What were the corrective actions to do the job safer?
