Title Page
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Work Order No.
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Job Safety Observation
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Site / Depot
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Conducted on
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Prepared by
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Location
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Personnel - Observation Team
People
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Is PPE being used as required?
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Type details of incorrect PPE
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Compliance with JSA or other procedures confirmed
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Type details of JSA or procedure failure here
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Is appropriate behaviour shown
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Type details of inappropriate behaviour here
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Are Personnel adequately trained for task
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Type details of training concerns here
Tools/Plant/Facilities
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Are tools appropraite for task
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Type details of inappropriate tools here
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Have tools/plant been inspected before use
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Type details of failed inspections here
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Is all gear maintained and serviceable? eg. slings, cables etc.
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Type details of of all equipment that is not being sufficiently maintained
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Are all Electrical tools or plant being used in good condition and safe to use? eg. tested, tagged
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Type details of all electrical issues here
Environment
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Is access and egress safe
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Type details of access/egress issues here
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Good Housekeeping? eg. are tools packed away, is site tidy and free of tripping hazards
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Type details of bad housekeeping here
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Are all noise, dust, odour, or discharge concerns being addressed in a safe manner?
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Type details of any noise, dust, odour, discharge issues here
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Is the environment being protected during the works? eg. fuels and chemicals stowed correctly, vegetation being considered
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Type details of environment concerns here
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Is the waste being managed correctly? eg. spoil, bitumen
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Type details of bad waste management here
Systems
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Is Job Analysis Complete and appropriate for task
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Type details of no JSA or inappropriate JSA here
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Are all procedures being followed
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Type details of failed procedures here
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For any works that requires an isolation, water or sewer, is the isolation effective?
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Type details of failed or poor isolation here
Discussion
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Discuss the JSO with all personnel and note outcomes of discussion
Follow Up Actions
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After completing the JSO and having discussions with all personnel on-site, are you free of any follow up actions?
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Type all actions required here. Include who will be responsible for those actions and when the follow up should be completed.