Audit

YYK Maritime
Safety Observation Card System

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Date & Time (remember to change if reporting later) =====>

Vessel/area

Observation Type

Positive

"At Risk" action

Unsafe Condition

Near Miss

Stop Work Authority Exercised

Area (further detail /other side)
Activity

If activity was not mentioned in the list, please write here:

Potential - High (permanent disability/fatality/major spill/serious damage)

Safety Actions and Observations - choose from relevant options

Personal Behavior

Lifting/Pulling/Pushing/Carrying

Eyes on task

Safe working position (line of fire)

Use of PPE (selection and condition)

Environment (Housekeeping,lighting,stable surface,other jobs in area,etc)

Equipment (Right for the job,isolation in place,fall harnesses,ladders,etc)

Procedures (PTW,Risk Assessment, aware of procedure,observing the rules,etc)

Reason for Behavior

Observation Details

Action Taken / Recommended

Request Safety Department comments

Observer Name

Observer

Signature. Name or unique ID + sign to the right. =========>

Push the "export" button, and e-mail the report to ron@yykinc.com
DO NOT push the "Finish" button until you have e-mailed the report.

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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.