Template to be used out in the field to record Safety Interactions / Observations.
GO DIGITAL TODAY Convert your paper checklists into digital forms
Scan this QR code to use this paper checklist on your smartphone or tablet. Visit www.iauditor.com
Site / Location.
Date of Safety Interaction.
Describe the Task Being Performed.
Name of Person/s Being Observed.
Detail Content of Any Conversations.
Did You Make Any Positive Observations ?
At Risk Observations / Conditions
Opportunities For Improvement / Corrective Actions
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to
take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment;
or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is
permissible in your workplace or jurisdiction.
Still haven't found the checklists you were looking for?