Go digital today!
Convert your paper checklists into digital forms
Scan this QR code to use this paper checklist on your smartphone or tablet orvisithttps://safetyculture.com/
Information
Document No.
Audit Title
Client / Site
Conducted on
Prepared by
Location
Personnel
Work Place Condition
Environmental
Tools And Equipment
Housekeeping
Guards and Barriers
Workplace Design
Add media
Safety Management
Appropriate Permits
FLRA Quality
Safe Work Practices Followed
Lock-out/Tag out used
Add media
Behaviours
Good attitude to work and workplace
Worker updates FLRA with bystanders
Good housekeeping attiitude
Using correct PPE
Positions (ergonomics/bystanders)
Following Standard Operating Procedures
Using tools and equipment properly
Understands emergency procedures
Recognizes need to change unsafe behaviours
Add 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
Add signature
Add signature
Add signature
Completed By and Date
Select date
Add signature
Steve Janknegt
Visible Felt Leadership (VFL)
Print as PDF
The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions.The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice.You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction.You should independently determine whether the template is suitable for your circ*mstances.
