Visible Felt Leadership (VFL)

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Work Place Condition

• Environmental

  Safe

  Unsafe

• Tools And Equipment

  Safe

  Unsafe

• Housekeeping

  Safe

  Unsafe

• Guards and Barriers

  Safe

  Unsafe

• Workplace Design

  Safe

  Unsafe

• Add media

  Media

Safety Management

• Appropriate Permits

  Safe

  Unsafe

• FLRA Quality

  Safe

  Unsafe

• Safe Work Practices Followed

  Safe

  Unsafe

• Lock-out/Tag out used

  Yes

  No

  N/A

• Add media

  Media

Behaviours

• Good attitude to work and workplace

  Safe

  Unsafe

• Worker updates FLRA with bystanders

  Safe

  Unsafe

• Good housekeeping attiitude

  Safe

  Unsafe

• Using correct PPE

  Safe

  Unsafe

• Positions (ergonomics/bystanders)

  Safe

  Unsafe

• Following Standard Operating Procedures

  Safe

  Unsafe

• Using tools and equipment properly

  Safe

  Unsafe

• Understands emergency procedures

  Safe

  Unsafe

• Recognizes need to change unsafe behaviours

  Safe

  Unsafe

• Add media

  Media

What work behavior was obsereved

What was said? (Reinforcement/Correction)

Follow-up actions (corrective actions not able to be rectified)

Worker(s) Observed and signed

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

Completed By and Date

• Select date

  Date

• Add signature

  Sign