AGFAB ENGINEERING HSE Observation Form (Various Locations) Revised 4-12-2013

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Work Environment and Conditions

• Housekeeping and Layout

  Safe

  At Risk

  N/A

• Security of equipment

  Safe

  At Risk

  N/A

• Barricades and Signage

  Yes

  No

  N/A

• Environmental Controls

  Yes

  No

  N/A

Systems/Standards/Procedures

• Lock-out and Tag-out

  Yes

  No

  N/A

• Work Permits

  Yes

  No

  N/A

• Competence for Task - Is evidence available for Licensing for High Risk Plant and or Certificates of Competency where required

  Yes

  No

  N/A

SWMS - Pre Start Checks - MSDS

• Available

  Yes

  No

  N/A

• Adequate

  Yes

  No

  N/A

• Understood

  Yes

  No

  N/A

• Followed

  Yes

  No

  N/A

Tools and Equipment

• Condition

  Safe

  At Risk

  N/A

• Availability

  Yes

  No

  N/A

• Plant is parked in designated areas / Equipment stored in a safe manner ?

  Yes

  No

  N/A

People and Behaviours

• Are employees Assessing and Re-assessing the area ?

  Yes

  No

  N/A

• Are employees maintaining Eyes on Path whilst moving around the worksite ?

  Yes

  No

  N/A

• Are employees Looking Before Moving ?

  Yes

  No

  N/A

• Are employees selecting appropriate Tools and Equipment and wearing correct PPE ?

  Yes

  No

  N/A

• Are employees keeping Eyes on Hands whilst doing works which could result in injury ?

  Yes

  No

  N/A

• Are employees ensuring they are not placing themselves in Line of Fire ?

  Yes

  No

  N/A

• Are employees Communicating their intent to others ?

  Yes

  No

  N/A

• Are employees using correct manual handling techniques to maintain correct Position and Effort ?

  Yes

  No

  N/A

Protection systems

• Is electrical equipment positioned appropriately with current test and tag ?

  Yes

  No

  N/A

• Are fire extinguishers positioned correctly with clear access and in test and tag ?

  Yes

  No

  N/A

• Are hazardous substances used and stored correctly with MSDS available ?

  Yes

  No

  N/A

High Risk Activities

• Are Confined Space Entries being carried out in accordance with procedural requirements ?

  Yes

  No

  N/A

• Are Trenching activities being carried out in accordance with legislative requirements ?

  Yes

  No

  N/A

• Are activities being carried out On, Over or Near Water being undertaken in a safe manner

  Yes

  No

  N/A

• Are employees using appropriate controls for ascending and descending to and from work areas >2mt

  Yes

  No

  N/A

• Has a Traffic Management Plan been developed for the site/is compliance observable ?

  Yes

  No

  N/A

POSITIVE OBSERVATIONS

• Note Positive Observations:

  Yes

  No

  N/A

AT RISK OBSERVATIONS

• Provide a sketch of the area of concern if applicable to support findings

  Drawing

• WORKPLACE MANAGER SIGN OFF

  Sign

• PERSON CONDUCTING THE SITE OBSERVATION

  Sign

• Select date

  Date

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