Title Page

  • Work Order No.

  • Job Safety Observation

  • Site / Depot

  • Conducted on

  • Prepared by

  • Location
  • Personnel - Observation Team


  • Is PPE being used as required?

  • Type details of incorrect PPE

  • Compliance with JSA or other procedures confirmed

  • Type details of JSA or procedure failure here

  • Is appropriate behaviour shown

  • Type details of inappropriate behaviour here

  • Are Personnel adequately trained for task

  • Type details of training concerns here


  • Are tools appropraite for task

  • Type details of inappropriate tools here

  • Have tools/plant been inspected before use

  • Type details of failed inspections here

  • Is all gear maintained and serviceable? eg. slings, cables etc.

  • Type details of of all equipment that is not being sufficiently maintained

  • Are all Electrical tools or plant being used in good condition and safe to use? eg. tested, tagged

  • Type details of all electrical issues here


  • Is access and egress safe

  • Type details of access/egress issues here

  • Good Housekeeping? eg. are tools packed away, is site tidy and free of tripping hazards

  • Type details of bad housekeeping here

  • Are all noise, dust, odour, or discharge concerns being addressed in a safe manner?

  • Type details of any noise, dust, odour, discharge issues here

  • Is the environment being protected during the works? eg. fuels and chemicals stowed correctly, vegetation being considered

  • Type details of environment concerns here

  • Is the waste being managed correctly? eg. spoil, bitumen

  • Type details of bad waste management here


  • Is Job Analysis Complete and appropriate for task

  • Type details of no JSA or inappropriate JSA here

  • Are all procedures being followed

  • Type details of failed procedures here

  • For any works that requires an isolation, water or sewer, is the isolation effective?

  • Type details of failed or poor isolation here


  • Discuss the JSO with all personnel and note outcomes of discussion

Follow Up Actions

  • After completing the JSO and having discussions with all personnel on-site, are you free of any follow up actions?

  • Type all actions required here. Include who will be responsible for those actions and when the follow up should be completed.

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.