ACRWORLD ASSIGNMENT SAFETY OBSERVATION

• Company Name

  Select
• Location
  Address

• Company Representative (name and title)

• Conducted on

  Date

• Prepared by (name and title)

Copyright

• All rights reserved. No part of this document may be reproduced or transmitted in any form by any means, electronic or mechanical, including photocopying and recording, or by an information storage or retrieval system, accept as may be permitted, in writing, by ACRWORLD .

Confidentiality Statement

• In order to maintain the integrity and credibility of the risk analysis processes and to protect the parties involved, it is understood that ACRWORLD and its representatives will not divulge to unauthorised persons any information obtained during this WHS Evaluation unless legally obliged to do so.

Scope:

• Focused Observation: During the site visit, focus on key aspects such as workplace layout, equipment usage, and employee practices. Clear Notation: Note down any potential hazards, non-compliance issues, or safety improvements needed in concise, specific terms. Immediate Reporting: Report your observations promptly, ensuring timely corrective actions and a safer work environment.

• Purpose of visit:

• Identify what was observed or who you spoke to (for example, Sam Smith, ACRWORLD, Project Manager)

• Detail the observation/discussion. (for example, Sam advised his role has changed from the original brief, he is now working alone installing light bulbs, he is concerned being alone on a ladder)

• Identify what was observed or who you spoke to (for example, Sam Smith, Project Manager)

• Should the placement continue?

  Yes

  No

  N/A

• Provide Detailed Information as to why the placement will be terminated.

• Actions required (if placement SHOULD continue), including consultation, cooperation, and coordination of activities with the host employer on any corrective actions.

• undefined

• Is there any Corrective Actions Required?

  Yes

  No

  N/A

• List all corrective action which must occur?

• Who is Responsible to complete the corrective actions?

• When does the corrective action need to be completed by?

  Date

• Provide Evidence that it has been completed.:

• EXECUTED BY:

• Position:

• Signature:

  Sign

• Date:

  Date

• Additional Notes: