Safety Observation Report Example Template | Free Download

Safety observation report example

About the Safety observation report example

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:

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.
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.
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.
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.
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.

Related categories

Preview of the template

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

This template, developed by Lumiform employees, serves as a starting point for businesses using the Lumiform platform and is intended as a hypothetical example only. It does not replace professional advice. Companies should consult qualified professionals to assess the suitability and legality of using this template in their specific workplace or jurisdiction. Lumiform is not liable for any errors or omissions in this template or for any actions taken based on its content.