Document Title: Observation Checklist
Issue Date: 05-Mar-2022
Rev. 00
Report no.:
Date: ________________________
Exact
Work
SR
Observation
Location
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Abrasive blasting/Coating/Painting
Access/Egress
Adverse Weather Conditions
Behavioral Based Safety
Compressed Gas Cylinders
Confined Space Entry
Electrical Hazards
Environmental Pollution
Ergonomics
Excavation Safety
Fall Protection
Inspected by:
Name:
Company:
Title:
Signature:
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
Corrective Action
Falling Material
Fire Hazards
Hazardous Loading
Hazardous Materials Management
Hot Works Safety
Housekeeping
Hygiene
Improper Manual Handling
Improper Material Storage
Inappropriate Personnel
Inadequate Maintenance
Checked by:
Name:
Company:
Title:
Signature:
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
Inspection and Recordkeeping
Lack of Barricade/Guard Rail/Protection
Lack of Watcher/Banksman/Rigger
Lifting / Heavy Equipment's
Lighting
Non-Standard Tool/Equipment
Over Exertion / Improper Work Position
Poisoning
PPE and RPE
PTW
Contractor /
Unsafe
Observation
Subcontractor
Act/
Status
Code
Responsible
Condition
34.
35.
36.
37.
38.
39.
40.
41.
42.
43.
Rigging / Lifting Operations
Scaffolding
Theft
Traffic Safety
Training
Unsafe Transport
Usage of Incorrect/Defective - Equipment/Tools
Vehicle Safety
Welfare Facilities
Work at Height
Radiation (Ionizing/Non-Ionizing)
Acknowledged by:
Name:
Company:
Title:
Signature: