City of Palmerston Worksite Visit - WHS Observation Report - duplicate

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Observation

• Is the employee working within job specifications?

  Yes

  No

  N/A

• Are there procedures for the task being preformed?

  Yes

  No

  N/A

• Does the employee know and understand the procedure?

  Yes

  No

  N/A

• Is the employee following the procedure or guidelines?

  Yes

  No

  N/A

• Has the employee been inducted?

  Yes

  No

  N/A

• Has the employee signed off on induction?

  Yes

  No

  N/A

• Is the employee using correct manual handling techniques?

  Yes

  No

  N/A

• If specialized equipment is in use, has the employee been trained and do they have appropriate licence?

  Yes

  No

  N/A

• Is the employee aware of the City of Palmerston injury/incident reporting procedures?

  Yes

  No

  N/A

• Is personal protective equipment required and is it being worn/used correctly?

  Yes

  No

  N/A

Details of WHS concerns/issues/hazards

• Hazard identified

• Add media

  Media

• Risk score

  None

  Low

  Medium

  High

  Extreme

• Corrective action

• By whom and date

• Hazard identified

• Add media

  Media

• Risk score

  None

  Low

  Medium

  High

  Extreme

• Corrective action

• By whom and date

• Hazard identified

• Add media

  Media

• Risk score

  None

  Low

  Medium

  High

  Extreme

• Corrective action

• By whom and date

• Hazard identified

• Risk score

  None

  Low

  Medium

  High

  Extreme

• Corrective action

• By whom and date

Additional comments

• Additional comments

• Corrective action comments.

• Employee name

  Sign

• Manager name

  Sign

• WHS Rep name

  Sign