Behavior-Based Safety Audit Form
Use this form to document a behavior-based safety audit, record observed behaviors, note hazards, and capture follow-up actions.
Audit Overview
Audit Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Site / Location Name
*
Department / Area Observed
*
Observer / Auditor Name
*
Shift / Time of Observation
*
Please Select
Day
Swing
Night
Other
Behavior Observation
Overall Safe Behavior Observed
*
Excellent
Good
Needs Improvement
Unsafe
Key Behavior Observation Checklist
*
Rows
Excellent
Good
Needs Improvement
Unsafe
PPE Use
1
2
3
4
Following Procedures
5
6
7
8
Communication / Awareness
9
10
11
12
Housekeeping
13
14
15
16
Equipment Handling
17
18
19
20
Hazards, Actions, and Follow-Up
Notable unsafe acts or conditions observed
*
Immediate corrective actions taken or recommended
*
Follow-up owner or next-step responsibility
*
Submit Audit
Should be Empty: