Title Page
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Document No.
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Audit Title
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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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Select date
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Add location
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What type of observation was made?
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Was the observation related to daily,routine work activities?
Observation Details
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Did your observation include Body Mechanics (ergonomics)?
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Please select any of the following items pertaining to the body mechanics (ergonomics) during the observation?
- Lifting / Lowering (over exertion)
- Pushing / Pulling (excessive force)
- Twisting / Bending
- Hand / Foot Placement
- Standing / Sitting / Kneeling (extended periods)
- Jumping (also includes to lower levels)
- Repetitive Motions
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Did your observation include Line-of-Fire?
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Please select any of the following items pertaining to the body positioning during the observation?
- Striking Against Objects
- Struck By Objects
- Caught: In/On/Between/Under Objects
- Inhailing/Absorbing/Swallowing Potentially Hazardours Substances
- Contact Temperature Extremes
- Contacting Electrical Current
- Falling
- Awkward Positions/Static Posture
- Repetitive Moves
- Over Extertion
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Did your observation include Tools, Equipment or Vehicles?
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Please select any of the following items pertaining to the Tools, Equipment or Vehicles observation?
- Correct Tool Use / Equipment for Job
- Guards / Handles and Safety Devices
- Pre-Use Inspection (Performed / Not Performed)
- Seatbelt / Restraint
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Did your observation include Tools, Equipment or Vehicles?
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Please select any of the following items pertaining to the Tools, Equipment or Vehicles observation?
- Correct Tool Use / Equipment for Job
- Guards / Handles and Safety Devices
- Pre-Use Inspection (Performed / Not Performed)
- Seatbelt / Restraint
