CWalk Work Contact Form

• Work Order Number

• Conducted on

  Date

• Observer(s)

• Location
  Address

• No. of People Contacted

• Worker(s) Observed

• Brief Summary of the TASK(s) OBSERVED during the Work Contact:

Category 1 - People & Competency

• Worker verified competent to perform work? - e.g. inducted, licence, tickets, white card, yellow card, certificates, SiteSafe etc

  Safe

  At Risk

  N/A

• Worker/s demonstrating competency in their approach to the work? Situational awareness (beyond the task at hand)? Observations below

  Safe

  At Risk

  N/A

• Changing position

  Safe

  At Risk

  N/A

• Rearranging job or task

  Safe

  At Risk

  N/A

• Stopping job or work

  Safe

  At Risk

  N/A

• Comments

Category 2 - Procedures & Planning

• Pre-start risk assessment - Take5, JSA, PRA, Hazard Prompt (or similar) conducted

  Safe

  At Risk

  N/A

• Is there a relevant procedure and/or SWMS specific to the task

  Safe

  At Risk

  N/A

• Is there a relevant Permit required and followed

  Safe

  At Risk

  N/A

• Are isolations adequate and verified

  Safe

  At Risk

  N/A

• Job preparation in place and free from hazards

  Safe

  At Risk

  N/A

Category 3 – Physical Environment

• Is there correct use of Tags/Locks

  Safe

  At Risk

  N/A

• Is barricading and applicable signage displayed

  Safe

  At Risk

  N/A

• Is there the correct Fire/Emergency equipment

  Safe

  At Risk

  N/A

• Lighting adequate and ventilation both in & outdoor

  Safe

  At Risk

  N/A

• Is emergency access clear

  Safe

  At Risk

  N/A

Category 4 – Tools & Equipment

• Are the correct tools/equipment being used

  Safe

  At Risk

  N/A

• Are tools/equipment in good condition

  Safe

  At Risk

  N/A

• Are all tool guards in place and operational

  Safe

  At Risk

  N/A

• Are all tools/equipment being used properly

  Safe

  At Risk

  N/A

• Electrical equipment and leads tagged & current

  Safe

  At Risk

  N/A

• Are earth leakage protection devices used

  Safe

  At Risk

  N/A

• Are there precautions for explosive tools on site

  Safe

  At Risk

  N/A

Category 5 – Body Use & Position

• Correct lifting, pulling, carrying, pushing position

  Safe

  At Risk

  N/A

• Clear of “Line of Fire”

  Safe

  At Risk

  N/A

• Eyes on path and work, appropriate pace

  Safe

  At Risk

  N/A

• Maintains 3 points of contact

  Safe

  At Risk

  N/A

• Ergonomic / Repetitive motion

  Safe

  At Risk

  N/A

Category 6 – Mobile Equipment

• Does all equipment have up to date log books

  Safe

  At Risk

  N/A

• Are operators appropriately licensed for its use

  Safe

  At Risk

  N/A

• Are all inspections conducted as per requirements

  Safe

  At Risk

  N/A

Category 7 - Housekeeping

• Are electrical leads/hoses stored appropriately

  Safe

  At Risk

  N/A

• Is the area free of slip and trip hazards

  Safe

  At Risk

  N/A

• Are necessary signs & posters displayed

  Safe

  At Risk

  N/A

• Hazard Observation process in place

  Safe

  At Risk

  N/A

• Are Work areas clean and tidy

  Safe

  At Risk

  N/A

Category 8 – Life Rules at CW

• Never work at heights without using the correct Personal Fall Protection devices correctly.

  Safe

  At Risk

  N/A

• Never commence work until all necessary Energy Isolations have been completed and permits are in place.

  Safe

  At Risk

  N/A

• Never enter a confined space or restricted area without appropriate training or authorisation.

  Safe

  At Risk

  N/A

• Never operate or modify any plant or equipment unless competent and authorised to do so.

  Safe

  At Risk

  N/A

• Never remove, bypass or modify a safety protection device without appropriate authorisation.

  Safe

  At Risk

  N/A

• Never direct or instruct another person to breach a life rule or undertake an activity which endangers life.

  Safe

  At Risk

  N/A

Category 9 – Quality

• Have the works been completed on time and to scope?

  Yes

  No

  N/A

• Was the area left clean and tidy & services connected where applicable?

  Yes

  No

  N/A

• Are fittings secure?

  Yes

  No

  N/A

• Confirm no hazards exist due to the works being performed.

  Yes

  No

  N/A

• Confirm no rectification works are required.

  Yes

  No

  N/A

• Has required works documentation been completed and filed?

  Yes

  No

  N/A

• Hazard Prompt Sheet or Pre-start Risk Assessment, SWMS been completed?

  Yes

  No

  N/A

• Have all permits been signed and returned – (e.g. work at heights, electrical isolation, confined space, hot works, Caltex permit)

  Yes

  No

  N/A

Category 10 - PPE

• Is necessary PPE being worn

  Safe

  At Risk

  N/A

• Is PPE adequate for the task

  Safe

  At Risk

  N/A

• Is PPE being worn properly

  Safe

  At Risk

  N/A

• Is PPE in good condition

  Safe

  At Risk

  N/A

• Adjusting PPE

  Safe

  At Risk

  N/A

Commendable BEHAVIOURS: (consider: planning, job set-up, communication methods, emergency response, PPE, etc.)

• Details

Identified AT RISK BEHAVIOURS or ISSUE:

• (i.e. that which relates to the Categories 1 – 9 e.g. Non-compliance with required PPE, wrong tool for job, incomplete documentation or works. These can be found as a checklist on the reverse side of this page)

Risk / Issue / Behaviours

• Category

  Select 1 - People & Competency 2 - Procedures & Planning 3 - Physical Environment 4 - Tools & Equipment 5 - Body Use & Position 6 - Mobile Equipment 7 - Housekeeping 8 - Life Rules at C&W 9 - Quality

  • 1 - People & Competency
  • 2 - Procedures & Planning
  • 3 - Physical Environment
  • 4 - Tools & Equipment
  • 5 - Body Use & Position
  • 6 - Mobile Equipment
  • 7 - Housekeeping
  • 8 - Life Rules at C&W
  • 9 - Quality

• Areas of Concern (a brief description of the At-Risk Behaviour or Issue to be addressed or commented on)

• Action Needed (When & by Whom)

• Name and Signature

  Sign

General OBSERVATIONS

• Observations