Safety Inspection Company Name: Date/Time: Location: Project #: Areas Inspected: Inspection Conducted By: Priority Index Severity 1. Imminent Danger 2. Serious 3. Minor 4. Negligible/Ok 5. Not Applicable Probability A- Probable B- Reasonably probable C- Remote D- Extremely Remote Person Hazard Hazard Description of Hazard Action Taken by Date & Time Recommended Action Responsible Number Priority (include location) (Signature) Completed for Action 1 2 3 4 5 6 7 Reviewed by Date: (Manager’s signature): Comments: SCSA LSE Proficiency Form
Safety Inspection Company Name: Date/Time: Location: Project #: Areas Inspected: Inspection Conducted By: Priority Index Severity 1. Imminent Danger 2. Serious 3. Minor 4. Negligible/Ok 5. Not Applicable Probability A- Probable B- Reasonably probable C- Remote D- Extremely Remote Hazard Number Hazard Priority Description of Hazard (include location) Recommended Action Person Responsible for Action Action Taken by (Signature) Date & Time Completed 1 2 3 4 5 6 7 Reviewed by (Manager’s signature): Date: Comments: SCSA LSE Proficiency Form