Behavioural Observation Form

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Personal Protective Equipment

• All applicable and appropriate PPE is being worn

  Yes

  No

  N/A

• Correct clothing is being worn

  Yes

  No

  N/A

• PPE and clothing is being worn correctly

  Yes

  No

  N/A

• Is the PPE and clothing effective and adequate

  Yes

  No

  N/A

Tools & Equipment

• Correct tools are being used for the job

  Yes

  No

  N/A

• Tools are in good condition

  Yes

  No

  N/A

• Tools are being used correctly

  Yes

  No

  N/A

Position of People

• Persons are not in the line of fire

  Yes

  No

  N/A

• Persons cannot be caught or struck by a moving load

  Yes

  No

  N/A

• Body parts are clear of hit and pinch points

  Yes

  No

  N/A

• Three points of contact are used at all times

  Yes

  No

  N/A

• Persons are not cramped or over extended for long periods

  Yes

  No

  N/A

• Bends at the knees when lifting and handling loads

  Yes

  No

  N/A

• Load is kept close to the body and has a straight spine

  Yes

  No

  N/A

• Mechanical lifting aids used where possible

  Yes

  No

  N/A

Permits & Isolations

• Isolations have been performed correctly

  Yes

  No

  N/A

• The correct permit(s) are in place for the work

  Yes

  No

  N/A

Documented Systems of Work

• Persons follow Safe Working and Operating Procedures

  Yes

  No

  N/A

• A JHA has been completed for the job

  Yes

  No

  N/A

• All team members have read and signed the JHA

  Yes

  No

  N/A

• A Take 5 was carried out before the work commenced

  Yes

  No

  N/A

• Correct procedures are being followed

  Yes

  No

  N/A

Vehicles / Plant Operation

• Pre-start checks have been carried out

  Yes

  No

  N/A

• Seat belts are being worn

  Yes

  No

  N/A

• Road and driving rules are being followed

  Yes

  No

  N/A

• Mobile phones are not being used while driving

  Yes

  No

  N/A

• Vehicles reverse parked in designated parking area

  Yes

  No

  N/A

Housekeeping

• The work area is clean and tidy

  Yes

  No

  N/A

• The work area is free of trips, slip and fall hazards

  Yes

  No

  N/A

• Spills are cleaned up immediately

  Yes

  No

  N/A

• The work area is barricaded and sign posted as required

  Yes

  No

  N/A

• Dust control/suppression is in place

  Yes

  No

  N/A

Competence

• All persons have the training, skill and VOCs for their tasks

  Yes

  No

  N/A

• All persons demonstrate that they are competent

  Yes

  No

  N/A

Health & Fitness for Work

• Drinking water is available

  Yes

  No

  N/A

• Water bottles are provided and used on site

  Yes

  No

  N/A

• Person's head nodding

  Yes

  No

  N/A

• Person excessive yawning

  Yes

  No

  N/A

• Person's speech slurred

  Yes

  No

  N/A

• Person has taken designated breaks

  Yes

  No

  N/A

Job Planning & Supervision

• The job has been well planned and organised and interfaces with others is well managed

  Yes

  No

  N/A

• Communication signals (hand, audio, etc.) are clear and understood by all persons (workgroup, spotter, operator, etc.)

  Yes

  No

  N/A

Hazard Identification

• All hazards have been identified and controlled and the work area is safe

  Yes

  No

  N/A

At Risk Behaviours Observed

Safe Behaviours Observed