REPORT OF UNSAFE ACTS AND CONDITIONS

Description
The Report provides an easy way to record unsafe acts and conditions found on a
construction site. Accompanying it are instructions and an example that describe and
illustrate its use. Standardized descriptors describe site conditions, potential accident or
injury, number of people affected, seriousness, cause, source, recommended fix, and
actual fix. Accident/injury descriptors coincide with nationally reported construction
accident/injury classes. Standardized abbreviations provide a shorthand way to describe
and classify observations. They are also useful for recording, analyzing, transmitting, and
reporting data in a computer database.

Anyone can use the Report including journeymen, foremen, superintendents, and project
managers; employed by anyone including prime contractors; subcontractors, owners,
architects, and engineers; on any type of construction site. It may be used by those with
authority over the work. Others may use it to describe unsafe acts and conditions and
alert supervision of their existence. Recording the actual fix (or lack of fix) documents
actions taken to remove unsafe acts and conditions.
This file contains the following:

• Report of Unsafe Acts and Conditions

• Example of completed Report
• Instructions for Filling Out Report.

The Report is part of the effort of the Safety Action Group of the Labor, Owner,
Contractor Summit of Southeast Michigan. The authors welcome feedback (including
samples) from users and suggestions for improvement.

Authors
Robert I. Carr, Ph.D., P.E. Forrest A. Henry
Professor of Civil Engineering Assistant Executive Vice President
Department of Civil and Environmental Associated General Contractors of America
Engineering Greater Detroit Chapter, Inc.
2340 G. G. Brown 23999 Northwestern Highway, Suite 150
University of Michigan Southfield, MI 48075-2579
Ann Arbor, MI 48109-2125 (248) 948-7000 Fax: 948-7008
(734) 764-9420 Fax: 764-4292 Email: FAHenry@ibm.net
Email: RICarr@umich.edu

Availability
© 1998 by R. I. Carr and F. A. Henry. The Report of Unsafe Acts and Conditions may be
freely printed, copied, and used.
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By:

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Project:
Company:

UAC 4/15/98
Comments:
Dry/Wet/Snow/Ice:
wiNdy/Calm:
Report of Unsafe Acts and Conditions

Date:
Temperature:
F o

No. Description of Unsafe Act/Condition (weather, date) (how fixed)

Fall<6'; Fall>6'; Slip/Trip; struck BY; struck AGainst;

CAUGHT in/between; LIFTing; overEXERT; TOXic Potential Accident
substances; SUFfocation; ELECtric shock; or Injury
eXplosion; FIRE; Vehicle injury; OTHer

Number of People
rough estimate
Affected

1 to 5 (1= not serious, 5 = very serious) Seriousness

CaReLeSs; UNaware; SAFEty equipment;
construction EQuipment; MATerial; inSTRuction; Cause
WoRKeRs; TIME; COST; iNconvenient; work
ME; MY company; GC; CM; OWner; trade
Contractor; Supplier; OTher (name); Unknown
Source
DO; STOP; RePLace; RePaiR; Obtain/add;
Recommended
inSTRuct; COMmunicate; Test/inspect; Guard;
Mark/sign; reASsigN; MOVE Fix
FiXeD (identify);TeMPorary fix (identify); REPorted;
ACCeptable condition; NOThing done
Actual Fix

R.I.Carr, F.A.Henry
Report of Unsafe Acts and Conditions SAMPLES (shown in italics)

Potential Accident

Number of People
Project: Towers Building

Recommended
Company: BIG

Seriousness

Actual Fix
By: J.
J.Doe
Doe Date: Feb 8, 1999

Affected
or Injury

Source
30 oF

Cause
Dry/Wet/Snow/Ice: D wiNdy/Calm: N Temperature:

Fix
No. Description of Unsafe Act/Condition (weather, date) (how fixed)

1 ladder not tied off (tied off) F>6' 25 2 CRLS GC DO FXD

2 delivery drivers don't wear hardhats BY 1 2 N S COM NOT

3 unbraced forms BY 5 4 UN C STR NOT

4 unshielded arc welding TOX 20 2 N C DO REP

5 work in 10' unsupported trench (stopped work, got shield) SUF 4 5 COST C DO FXD

6 walking too close to trucks (need barricade) (sawhorses) V 20 3 SAFE GC M TMP

7 unguarded roof openings 4'x4': 12 (cleared roof) F>6' 12 4 CRLS C G TMP

8 uncovered rebar ends, vertical, 100 AG 20 4 N C G NOT

o
9 ice on stairs (D/C/35 , Feb 9, 99) S/T 40 4 COST GC DO NOT

10 steel bands from boxes litter walkway (cleaned up) S/T 20 2 IN C DO FXD

11 paint spray and fumes TOX 10 3 SAFE C O NOT

12 2nd floor guard rail is broken (replaced rail) F>6' 20 4 CRLS GC RPR FXD

13 trash is thrown off 2nd floor (well barricaded) BY 10 3 CRLS C STOP ACC

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Fall<6'; Fall>6'; Slip/Trip; struck BY; struck AGainst;

FiXeD (identify);TeMPorary fix (identify); REPorted;

CAUGHT in/between; LIFTing; overEXERT; TOXic

Comments: (7) Need to get plywood to guard roof openings

construction EQuipment; MATerial; inSTRuction;

inSTRuct; COMmunicate; Test/inspect; Guard;

Contractor; Supplier; OTher (name); Unknown
WoRKeRs; TIME; COST; iNconvenient; work

(2) Need better site check-in system so visitors/ vendors wear hard hats.
DO; STOP; RePLace; RePaiR; Obtain/add;
substances; SUFfocation; ELECtric shock;

CaReLeSs; UNaware; SAFEty equipment;

ME; MY company; GC; CM; OWner; trade

1 to 5 (1= not serious, 5 = very serious)
eXplosion; FIRE; Vehicle injury; OTHer

ACCeptable condition; NOThing done

(11) Painters say they will not wear masks.

Mark/sign; reASsigN; MOVE
rough estimate

UAC 4/15/98 R.I.Carr, F.A.Henry

 INSTRUCTIONS FOR FILLING OUT REPORT
1. Who should use this Report: This Report may be used by any person on a jobsite, from a journeyman to a
project manager. It is an easy way to describe unsafe acts and conditions and alert supervision of their existence. If
you do not have authority to correct an unsafe act or condition, give this Report to someone who can take
appropriate action.

2. Background Information: In the top left corner of the Report, enter the name of the project, the company
employing you, your name, the date you made the Report, and weather conditions at the work area where the
unsafe act/condition exists. E.g. Dry = D, wiNdy = N.

3. Describe the Unsafe Act or Condition: In the rows 1 through 20, briefly describe unsafe acts or conditions.
Enter one unsafe act/condition per line. If you need additional space for an act/condition use more than one line.
Insert weather and/or date if different from Background Information. Actual fix can be described, in parentheses.

4. Fill in the Columns: On the right half of the form in the same row that you described the unsafe act/condition,
give additional information about the act/condition by filling in each of the seven columns. Select from the options
described at the bottom of each column. Use the bold-faced letters in each option as the abbreviation for that
option. The columns ask you to identify a) the potential accident/injury, b) the number of people exposed to the
act/condition, c) the seriousness of the potential injury/accident, d) the cause, e) the source, f) your recommended
fix, and g) the actual fix.

4(a). Potential Accident or Injury: From the list at the bottom of this column, select the most likely accident or
injury that could result from the unsafe act/condition and mark its abbreviation in the column. The abbreviation
consists of the bold-faced letters. E.g. Fall less than 6 ft. = F<6; slip/trip = S/T.

4(b). Number of People Affected: Give a rough estimate of the number of persons who would be injured if the
unsafe condition results in an accident.

4(c). Seriousness: On a scale of 5 (1 = not serious, 5 = very serious), how serious is the potential accident?

4(d). Cause: From the list at the bottom of this column, select the most likely cause of the accident that could
result from the unsafe act/condition, and mark its abbreviation in the column. E.g. CaReLeSs = CRLS.

4(e). Source: From the list at the bottom of this column, select the person or company to whom you attribute
the existence of the unsafe act or condition, and mark its abbreviation. E.g. Mark ME if you are the source of
the unsafe act/condition. Your company = MY, general contractor = GC, construction manager = CM, architect
= OT(arch), Mr. Brown = OT(Brown) or OT(Brn).

4(f). Recommended Fix: In this column identify the action you believe should be taken to correct the unsafe
act or condition. The bold letters provide an easily used abbreviation. E.g. RePlace = RP. The options are:
(1) DO = Do it a safe way.
(2) STOP = Stop doing it.
(3) RePlace (RP) = Replace broken/malfunctioning/unsafe item.
(4) RePaiR (RPR) = Repair broken/malfunctioning/unsafe item.
(5) Obtain/add (O) = Obtain or add an item to eliminate the unsafe condition.
(6) InSTRuct (STR) = Instruct how to do it a safe way.
(7) COMmunicate (COM) = Communicate the information that would allow the work to be done safely.
(8) Test/inspect (T) = Test or inspect to see if it is safe.
(9) Guard (G) = Install a physical barrier to isolate persons from the unsafe act/condition.
(10) Mark/sign (M) = Mark or erect signs to identify the unsafe act/condition.
(11) ReASsigN (ASN) = Reassign the work to qualified persons.
(12) MOVE = Move people away from the hazard or move the hazard away from the people.

4(g). Actual Fix: Describe what was done to fix the unsafe act/condition. Actual Fix can be filled in by person
who receives the report and is responsible for taking action. Detail on actual fix can be added in parentheses in
Description of act/condition.

5. Comments: In bottom left section write additional information. Reference a particular unsafe act/condition by its
number.

UAC 4/15/98 R.I.Carr, F.A. Henry