Worksite Safety Observation

• Audit Title

• Document No.

• Site Location of Task/Activity

• Task/Activity Observed

• Conducted on

  Date

• Prepared by

• Personnel

Pre-Start Observations

• Has a Pre-Task Plan (JHA) been completed before the task?

  Safe

  At Risk

  N/A

• Has all work procedures and hazard control measures been reviewed and understood by all employees prior to the task/activity?

  Safe

  At Risk

  N/A

• Has stretch and flex exercises been performed by all employees prior to starting task?

  Safe

  At Risk

  N/A

• Has all restricted work areas and exclusion zones been erected, including signage?

  Safe

  At Risk

  N/A

Personal Protective Equiment

• Are hardhats, safety glasses and hi-visibility vest being worn by all employees (mandatory)?

  Safe

  At Risk

  N/A

• Are hands protected when working with tools, sharp objects, chemicals, hot or cold items?

  Safe

  At Risk

  N/A

• Is appropriate footwear being worn?

  Safe

  At Risk

  N/A

• Is hearing protection being used in high noise areas?

  Safe

  At Risk

  N/A

• Is respiratory protection needed and being used when vapors, dusts, etc., are present?

  Safe

  At Risk

  N/A

• Is fall protection available and being used properly when needed?

  Safe

  At Risk

  N/A

Employees Body Position

• Are employees using proper lifting and twisting techniques?

  Safe

  At Risk

  N/A

• Are employees protected from the "Line of Fire"? Caught-in, Struck-by, Energy Release

  Safe

  At Risk

  N/A

• Are employees keeping their hands out of the danger zone?

  Safe

  At Risk

  N/A

• Are employees staying focused...Eyes on Path (slips, trips and falls)?

  Safe

  At Risk

  N/A

• Are employees properly ascending/descending ladders (free of trip hazards)?

  Safe

  At Risk

  N/A

Tools & Equipment

• Has an inspection been conducted on all tools, equipment, extension cords, etc., prior to the task/activity?

  Safe

  At Risk

  N/A

• Are employees using the correct tools for the task/activity?

  Safe

  At Risk

  N/A

• Are the tools being used in good condition (guards, cords, handles, etc.)?

  Safe

  At Risk

  N/A

• Is a GFCI being used with electrical tools?

  Safe

  At Risk

  N/A

• Are flammable materials removed from the area when using electrical tools?

  Safe

  At Risk

  N/A

Housekeeping

• Are walking and working surfaces free of debris and tripping hazards?

  Safe

  At Risk

  N/A

• Is the work area neat, clean and free of obstructions?

  Safe

  At Risk

  N/A

• Are flammables and combustibles stored properly?

  Safe

  At Risk

  N/A

• Are work areas free of impalement hazards?

  Safe

  At Risk

  N/A

Working at Heights

• Is fall prevention (guardrails) or personal fall arrest systems (harness/SRL) in place and being used properly?

  Safe

  At Risk

  N/A

• Are ladders being used in a safe manner and appropriate for the task?

  Safe

  At Risk

  N/A

• When aerial lifts are being used, are employees using PFAS and tying off?

  Safe

  At Risk

  N/A

Excavations

• Has a trench log been completed prior to the task?

  Safe

  At Risk

  N/A

• Are all excavations greater than 5 feet properly sloped, shored benched?

  Safe

  At Risk

  N/A

• Are ladders placed every 25 feet of lateral movement and do they extend 3 feet above lower landing?

  Safe

  At Risk

  N/A

• Are spoil piles a minimum of 2 feet away from excavation wall?

  Safe

  At Risk

  N/A

• Are employees working in a trench that has water accumulating (ground water or surface water)?

  Safe

  At Risk

  N/A

Heavy Equipment / Vehicles

• Has an pre-trip inspection been conducted on all heavy equipment prior to commencing the job?

  Safe

  At Risk

  N/A

• Does the equipment operator drive the equipment at a safe speed?

  Safe

  At Risk

  N/A

• Does the equipment operator park the equipment in a safe location and lower all attachments before exiting equipment?

  Safe

  At Risk

  N/A

• Does the equipment operator look back prior to backing equipment up?

  Safe

  At Risk

  N/A

• Does the equipment operator use 3 points of contact when entering/exiting equipment?

  Safe

  At Risk

  N/A

• Does the equipment operator use the horn before entering a blind intersection or before moving in any direction?

  Safe

  At Risk

  N/A

• Does the driver park the vehicle in a safe location?

  Safe

  At Risk

  N/A

• Does the driver use the 5 keys of Smith System driving (aim high, get the big picture, keep your eyes moving, leave yourself an out and make sure they see you)?

  Safe

  At Risk

  N/A

Comments

• Safe Acts observed within the task. What were the safe act/acts observed?

• Unsafe Acts observed within the task. What were the unsafe act/acts observed?

• Discussion Points/Agreed Corrective Measures

Signatures

• Observers Signature

  Sign

• Team Member Signature

  Sign

• Team Member Signature

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• Team Member Signature

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• Team Member Signature

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• Team Member Signature

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