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Safety observation report example

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Audit
Was a safety review or a discussion about safety conducted before work was started today?
What was the topic of the conversation?
Housekeeping
Exits & stairways free of debris/material/tools
Sidewalks & walkways are free of debris/materials/tools
Materials are organized and consolidated
Nails are bent over or removed to prevent implement hazards
Lunch trash is disposed of after eating
Construction trash removed at the end of the job or at least daily
Head Protection
Worn as required (curb to curb and can be removed inside a completed home or during breaks with no overhead hazards)
Worn correctly and in good condition
Hand Protection
Worn as required while working with chemicals or tools
Correct hand protection worn for the hazard
Eye Protection
Correct eye protection worn (ANSI-Z87)
Worn while using nail guns, hammers, or powder actuated tools
Worn while using saws, drills, grinders or clippers
Used while working with hazardous substances
Respirators & Dust Masks
Dust masks are rated as N-95 if worn
Respirators worn when spraying paints or stains
Worn when mixing chemical based materials
Worn when spraying or installing insulation
Tools & Equipment
All moving parts on the tool/equipment is guarded
Power cords are in good condition
Hand & Electric tools are in good working condition
Generator/ Compressor in good condition
Seat belts worn on all moving equipment (tractors, bobcats, forklifts, etc.)
Mobile equipment have audible back up alarms or a designated spotter (tractors are not required to have audible alarm)
Ladders
Ladders are in good condition without alterations
3 points of contact are maintained while ascending/descending the ladder (cannot hand carry equipment or material while climbing)
Extension ladders are secured from displacement and are at a 4:1 lean ratio
Extension ladders are set up with a minimum of 3' above the "landing" area when using the ladder to access another area
No worker is standing on the top 3 rungs of an extension ladder
Folding ladders are used in the full open position only
No worker is standing on the top step or the top of the ladder
Folding ladders are set up on a clear & level surface
Fall Protection
What type of fall protection is being used
Does the worker have the Safety & Fall Protection Plan with them on site as required
Are workers using the Personal Fall Arrest System correctly? (Visually check for anchor, lanyard, harness, yo-yo, rope grab, swing radius)
Are scaffold jack systems set up and used correctly
All holes in roof/floor greater than 2" are protected against with a cover
Wall openings are guarded where fall heights of 6' or more are present (window openings)
Wall openings are guarded where fall heights of 6' or more are present (where studs are more than 18" apart)
Are the safety/guard rails installed and secured (stairwell, open lofts, decks)
Are top and mid rails in the guard rail system installed at the correct height (top rail 42" +/- 3", mid rail centered half way between top rail and working platform)
Implement Hazards protected against
Scaffolding (Lath & Plaster)
Is the scaffolding set up level
Are the work platforms full planked with good scaffold planks
Are base plates installed on all horizontal pieces
Are mud sills installed under all base plates if required
Are access ladders supplied to all work levels of the scaffold platforms
Is all bracing installed at each scaffold segment as required
Are the side and end rails (top & mid) installed at the 10' trigger height and higher
Is the scaffold structure secured to the building every 12' in height and 20' of length
Are implement hazards protected against
Is the scaffolding no more than 18" away from the structure
Excavations
Are the excavations that are 2' or deeper marked with warning tape
Are ladders used to access the excavation if its 4' or deeper
Are spoil piles a minimum of 2' from the excavation edge
Are shield boxes used at all excavations that are 5' or deeper
Are benched soils done correctly (only allowed in Type B Soils, basement & pool excavations)
Are soils sloped correctly (Type C soils-1 1/2:1 ratio only)
Are implement hazards protected against
Basement excavations have fences up and installed with warning signs posted
Basement fall protection cables are installed, tensioned and flagged every 6'
MSDS/Fire Protection
All chemical containers are labeled with the manufactures information and is legible
Does the worker have their companies MSDS book available for review
Are workers who are doing hot work have a fire extinguisher with them during the hot work
Are workers using open flame burners/stoves inside the structures
Observer's Signature
Share this template:
Ensuring workplace safety is paramount in any industry. Whether you’re overseeing operations on a construction site or managing a manufacturing facility, detailed and standardized reporting is crucial. Our safety observation report example template helps you standardize your safety observations and findings, making it easier for you and your team to maintain a safe working environment. Use this template to enhance your safety protocols and maintain comprehensive documentation of all safety-related incidents.

Key elements of a safety observation report

A safety observation report template should be detailed and comprehensive. Here are the crucial components of a safety observation report template:
  1. Audit information: You’ll log here whether a safety review or discussion was conducted before work started. The topic of conversation is documented to make sure safety protocols are communicated effectively.
  2. Housekeeping: Verify if the worksite is clean and organized. For example, exits and stairways should be free of debris and materials being organized. A tidy workplace can prevent accidents and improve overall safety.
  3. Personal Protective Equipment (PPE): Check for correct usage and condition of head, hand, and eye protection, as well as respirators and dust masks. Proper PPE usage is a must for keeping workers safe.
  4. Tools and equipment: You’ll confirm if tools and equipment are in good working condition, including power cords, generators, and mobile equipment. By properly maintaining equipment, you can prevent accidents.
  5. Fall protection: This covers the type of fall protection used and checks for correct usage of personal fall arrest systems, scaffold setups, and protection of wall openings.

How to customize the safety observation report template

Customizing the safety observation report template to fit your specific needs is straightforward. The template is editable, so feel free to add these in:
  • Specific hazards: Tailor the template to include hazards that are relevant to your industry. For example, if you work in construction, add sections for scaffolding and heavy machinery. This way, you can cover more potential risks.
  • Your company’s protocols: Incorporate your company’s unique safety protocols and procedures so the template aligns with your internal safety standards. This might include PPE requirements or emergency procedures.
  • Additional observation fields: Add fields for extra observations that are particular to your work environment. These could be about environmental conditions, worker behavior, or operational practices.

Improve your safety management with Lumiform’s report template

Download our report template and enhance your workplace safety. With features like diverse fields, real-time data collection, and easy customization based on your existing protocols, it’ll allow you to prepare comprehensive safety documentation. Our user-friendly interface and mobile accessibility make it simple to conduct and analyze reports on the go.
Please note that this checklist template is a hypothetical appuses-hero example and provides only standard information. The template does not aim to replace, among other things, workplace, health and safety advice, medical advice, diagnosis or treatment, or any other applicable law. You should seek your professional advice to determine whether the use of such a checklist is appropriate in your workplace or jurisdiction.
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