Information

  • Observers Name

  • Position

  • Conducted on

  • Task being performed

  • Location

Personal Protective Equipment

  • Hand Protection

  • Barrier Identified

  • Eye Protection

  • Barrier Identified

  • Head Protection

  • Barrier Identified

  • Foot Protection

  • undefined

  • Hearing Protection

  • Barrier Identified

  • Respiratory Protection

  • Barrier Identified

  • Face Protection (Visor)

  • Barrier Identified

  • High Viz Clothing

  • Barrier Identified

Tools / Equipment

  • Suitable for job

  • Barrier Identified

  • Tools & cables condition

  • Barrier Identified

  • Correct Use

  • Barrier Identified

  • Tool Storage

  • Barrier Identified

Body Use / Position

  • Line of Fire

  • Barrier Identified

  • Pinch Points

  • Barrier Identified

  • Pushing / Pulling

  • Barrier Identified

  • Carrying

  • Barrier Identified

  • Walking - Eyes on the path

  • Barrier Identified

  • Careful during the work

  • Barrier Identified

Job Planning

  • Safe System of Work Performed

  • Barrier Identified

  • Understands the Risks Associated with the work

  • Barrier Identified

  • Communication with other parties / workers

  • Barrier Identified

  • Isolations / Lock out / Tag out system in place/ Guards In Place

  • Barrier Identified

Environment

  • Ground Working / Surfaces

  • Barrier Identified

  • Slip, Trip Hazards

  • Barrier Identified

  • Barriers, guards, awareness signs

  • Barrier Identified

  • Chemical Spill Prevention

  • Barrier Identified

  • Lighting

  • Barrier Identified

  • Housekeeping

  • Barrier Identified

  • Segregation of waste

  • Barrier Identified

Safety Procedure

  • Understands Emergency Procedure

  • Barrier Identified

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.