SAFE VISIT REPORT
Date:
Area visited:
Report Author (Supervisor):
e-mail addres:
Safe visit Team:
Number of People involved:
Group responsible for the work/activity area:
Activities observed:
1.
Leadership and commitment
Are the workers are aware about PTW, LMRA, etc.
Please select..
Best practice
OK (consistent)
Not OK (Inconsistent)
2.
Training
Are the workers inwolved aware of LMRA, Stop Work Authority, etc.
Please select..
Best practice
OK (consistent)
Not OK (Inconsistent)
3.
Zoning
Are there suficient signs for work zones, communication routes etc.?
Please select..
Best practice
OK (consistent)
Not OK (Inconsistent)
4.
Barricades
Is the site area properly fenced and protected? Are there warning signs at the entrance and outside the working area?
Please select..
Best practice
OK (consistent)
Not OK (Inconsistent)
N. A.
5.
PPE
Are proper PPE in place? Are workers aware of the usage and assessment of the condition of PPE?
Please select..
Best practice
OK (consistent)
Not OK (Inconsistent)
6.
Excavation
Are there excavation properly protected (entrance, guards and hard barricades are installed and fall protection is provided as required, etc.)?
Please select..
Best practice
OK (consistent)
Not OK (Inconsistent)
N. A.
7.
Scaffolding and Other Access
Are ladders, scaffolds and their access ways comply with international standards? Staircases should be the first option for access. Where ladders are used, access ladders must extend at least 92cm (3 feet) over any landing or scaffold platform. Swing gates or other barrier means must be used at the entry points to prevent falls.
Please select..
Best practice
OK (consistent)
Not OK (Inconsistent)
N. A.
8.
Housekeeping
Is waste management is properly organized on the site? First Aid Kit is in place and signed? Is the site is organized in line with HASP? Are stairways, passageways, ladders, scaffold and gangways free of material, supplies and obstructions?
Please select..
Best practice
OK (consistent)
Not OK (Inconsistent)
9.
Are there high risk activities carried on the site?
Are all risks included in PTW documentation? Are all controls in place? Is PH aware of all risks and controls
Please select..
Yes
No
PTW
Please select..
Best practice
OK (consistent)
Not OK (Inconsistent)
JHA
Please select..
Best practice
OK (consistent)
Not OK (Inconsistent)
WCF
Please select..
Best practice
OK (consistent)
Not OK (Inconsistent)
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