Title Page
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Site conducted
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Conducted on
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Prepared by
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Location
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Task / Activity Description
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Persons Involved
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Is there a Safe Working Procedure/Work Instruction available for the observed task being followed?
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For the observed task, was a ZERO-IN risk assessment conducted ?
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For an observed high risk task, was a Pre-Task Risk Assessment (PTRA) conducted?
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For an observed non-routine task, was a Pre-Task Risk Assessment (PTRA) conducted?
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Have the correct tools/equipment been identified and available at the point of work?
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Is the correct/suitable PPE identified and used by all involved?
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Do all employees involved in a task understand the risk control measures identified for the task? Interview personnel.
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Is everyone involved in or affected by the job been informed of the job, prior to commencing?