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FOR138-Observation Checklist Form (SafetyCulture Version Rev 01)
FOR138-Observation Checklist Form (SafetyCulture Version Rev 01)
David Hardman

FOR138-Observation Checklist Form (SafetyCulture Version Rev 01)

Observation Checklist Form - SafetyCulture Version Rev 01

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Free FOR138-Observation Checklist Form (SafetyCulture Version Rev 01) Checklist

Use this Template

Information

  • Personnel

  • Document No.

  • Project/Site

  • Location

  • People Observed

  • Conducted on

  • Location

  • Overall Site Photo

  • Prepared by

TRIGGERS

  • What is being done?

  • How is it being done?

  • What are the Hazards?

  • Who will get hurt?

  • Can it be done safer?

  • Is an accident about to occur?

General Observation Criteria

EMERGENCY RESPONSE

  • Are fire equipment (fire extinguishers/hose reels/fire blankets etc), extinguishing systems and detection systems (smoke alarms) properly maintained and not expired?

  • Are First Aid Kits properly maintained and contents are not expired?

  • Escape routes (Access & Egress) not blocked/obstructed?

  • Are Evacuation Diagrams adequate and secured in appropriate areas?

  • Are Emergency Contacts current and listed?

ENVIRONMENTAL (CONSTRUCTION)

  • Stockpiles of soil stabilised/sealed/covered?

  • Is spoil located away from drains/water courses?

  • Erosion controls in appropriate places?

  • Erosion controls in good working order?

  • Is storm water directed through silt fence where necessary?

  • Are erosion control measures inspected after storms/rain?

  • Hazardous substance compliance - use, storage & disposal?

  • Is a hydrocarbon spill kit on site?

  • Fuel storage and distribution, no leaks/spillage?

  • Plant and equipment has had scheduled maintenance performed?

  • Vehicles & plant - leaks, excessive fumes, spillage?

  • Plant & Equipment stored away from watercourses/drains?

  • Are all vehicles carrying dusty loads covered/watered over prior to leaving the site?

  • Are speed control measures applied (e.g. speed limit signs)?

  • Are dusty roads paved and/or sprayed with water?

  • Fibrous materials management - disposal/handling satisfactory?

  • Recycling requirements - metal, electrical cable, plastic, paper satisfactory?

  • Housekeeping/Work area cleanliness in order and waste contained effectively?

  • Waste receptacles are emptied regularly?

ENVIRONMENT (OFFICES)

  • All floor surfaces are clean, level, non-slip and free from damage, tripping hazards or obstructions (e.g. potholes or uneven surfaces)?

  • Work areas, Kitchen and Toilet amenities are clean?

  • Air temperature and flow is adequate?

  • Air-conditioning is regularly maintained and cleaned?

  • Lighting/Exit Signage sufficient and maintained?

  • Is the building plumbing in good working order (i.e. no leaks or drips)?

  • Hazardous substances are labelled, stored correctly and have MSDS information available?

  • Spill Kits are available and have sufficient contents?

  • Is the office free from distractive noise?

  • Is the site kept clean and tidy (e.g. litter free, good housekeeping)?

  • Is waste/recyclable waste and general refuse place in correct receptacles and removed off-site regularly?

PROCEDURES

  • All workers attended Pre-Work brief?

  • JSEA/Stay Safe Assessment completed?

  • Task is being completed following procedure?

  • Isolations are installed?

  • Fall protection is provided?

  • Permit is completed? (Hot Work, Confined Space etc)

  • Plant Inspections have been performed?

  • Hazard Areas are sign posted/restricted?

  • Supervision is adequate?

  • Task control measures have been applied?

PHYSICAL/ERGONOMICS

  • Eyes concentrating on task?

  • Hands positioned correctly when using equipment?

  • Avoidance of moving parts/debris?

  • Appropriate support when lowering or climbing (ladders/steps/stairs)?

  • Avoiding awkward postures?

  • Avoids Bending & Twisting?

  • Applies Manual Handling Techniques?

  • Takes appropriate breaks?

WEATHER

  • Adequate protection available (sunscreen, hydration, hats)?

  • Are conditions effecting the task?

  • Adequate controls have been put in place?

  • Equipment and Materials are secured from severe weather?

REACTIONS

  • Stressed/Avoids rushing?

  • Fatigue issue?

  • Physically well?

  • Alert/Stable position

HOUSEKEEPING

  • Hazard Materials are used/stored safely?

  • Waste appropriately controlled?

  • Slips/Trips & Fall Hazards are removed?

  • Walkways & Traffic areas are clear?

  • Spill Kits are supplied & available?

  • Adequate Waste receptacles?

PPE

  • Clothing/Body Protection (Hi-Vis, Aprons)?

  • Hearing (Ear defenders/plugs)?

  • Respiratory (P2 Dust/Full Face)?

  • Head/Eyes/Face (Hats, Glasses, Goggles, Face Shield)?

  • Footwear?

  • Gloves (appropriate for task)?

  • Jewellery/Accessories?

TOOLS & EQUIPMENT

  • Pre-Use Inspection/Condition?

  • Handling/Operated Safely?

  • Fit for Purpose?<br>

  • PPE is worn?

  • Handles fitted where required?

  • Guards are fitted and not modified?

ELECTRICAL

  • Leads free from defect, indicating employee inspected prior to use?

  • Cords elevated where possible?

  • Cables and leads supported on insulated hanger/hooks?

  • Plug terminations in good order?

  • Leads appropriately tagged for the current period?

  • Use of ELCB (RCD) with all portable electrical equipment?

  • Are all leads braided or reinforced?

FACILITIES/AMENITIES

  • Furniture and equipment is in good working order and maintained?

  • Access and Egress is free from obstruction and slip, trip and fall hazards?

  • Signage and barricading is effective and in good working order?

  • Speed limits are posted where vehicles travel?

  • Grounds are maintained clean?

  • Lighting is sufficient and in good working order?

  • Pest control is maintained and performed at appropriate intervals?

SCAFFOLDING

  • Is the Scaff-Tag appropriately displayed at the entry point to the scaffold indicating it's status for use?

  • Has the scaffold been inspected for the current period, weekly as a minimum?

  • Are cables and leads suspended from the scaffold supported on insulated hangers/hooks?

  • Is the loading on the scaffold in conformance with the scaffold rating (light, medium, heavy) duty stage?

  • Is the scaffold appropriately tied in?

  • Is the scaffold appropriately supported on sole boards?

  • Ladders secured, 1.4 metre lean and projecting 1 metre above platform?

  • Clear access & egress points to scaffold?

  • Sharp edges and scaffold clips covered on walkways?

STORAGE OF MATERIALS

  • Construction materials stored/laid out safely & accessible?

  • Material/equipment laid out on gluts/dunnage for ease of access?

  • Gang boxes/containers maintained in orderly fashion?

  • Base of ladders clear of loose material or obstructions?

  • Check for timber/walls/gluts/scaffold planks with protruding nails or screws?

  • Racking systems have current inspection certification?

  • Objects stored at height are secured from falling?

MATERIAL SAFETY DATA SHEETS (MSDS)

  • MSDS Register is maintained at an accessible location, know to employees?

  • MSDS are available for all products stored or in use by employees and contractors?

  • Product storage areas are provided with adequate segregation between products and other materials, warning signs displayed as per regulations?

  • Product usage is seen to be covered in the daily JSEA/Safe Work Instruction?

  • A copy of the MSDS is provided in the work pack as part of the work instruction for high risk classification products?

  • Daily use products are appropriately transported to/stored at the workface with precautions clearly identified?

  • Waste containers are appropriately disposed of after use?

  • Employees observed to be wearing the appropriate form of PPE in accordance with the requirements of the MSDS?

  • Hazardous Waste has MSDS attached?

SIGNS AND BARRICADING

  • Are appropriate warning signs and barricading displayed where hazards are evident?

  • Is barricading erected in an appropriate manner as to prevent inadvertent entry?

  • Provide photo evidence of barricading in-situ.

  • Are Information Tags being used and are legible?

  • Are there any signs or bunting that no longer apply and which should be removed?

  • Is the correct barrier tape or flagging being used to identify the hazard?

  • Is the intent of the barricading/warning signs being adhered to?

  • Are penetrations appropriately covered, barricaded and sign posted?

  • Is temporary construction signage removed when no longer required?

  • Are mandated exclusion zones delineated where the 50m rule cannot be implemented (e.g. barricades, signage, berms, hard barricade etc)?

MOBILE PLANT

  • Has the plant log book been completed by the operator as part of the pre-start check?

  • Guards are fitted and not modified?

  • Has a Spotter been provided where required?

  • Have adequate precautions such as flagging, cones or warning signs been erected to warn of hazards?

  • Lights/Audible Warnings in operation?

  • Stored/Parked correctly?

  • Loads appropriately secured?

  • Used in accordance with instructions/operated safely?

  • User has competency licence?

  • Are operators wearing the correct PPE for the task (e.g. safety harness for boom hoists)?

  • Over Centre Binders not used for load restraints?

JSEA

  • Has the JSEA been developed for the task and is readily accessible at the workface?

  • Have ALL personnel engaged in the task, signed onto the JSEA?

  • Has the JSEA been reviewed and signed by the job Supervisor?

  • In the case of a lower tier subcontractor has the JSEA been authorised by the principle contractor?

  • Does the JSEA identify Permit To Work requirements associated with the task?

  • Does the JSEA adequately reflect the task being performed?

  • Does the JSEA have an overriding Risk Assessment?

  • Are the JSEA task steps being followed?

  • Are the task steps in a logical sequence and easy to understand?

  • Have all potential hazards been identified (detail major hazards that have not been accounted for)?

  • Does the JSEA reflect any field modifications or other changes (traffic, environment etc)?

  • Have the hazards identified in the JSEA been identified in the Site Hazard Register?

OXY/FUEL GAS EQUIPMENT

  • Are cylinders secured in the upright position and separation distances maintained for bulk fuels?

  • Are cylinders transported by appropriate means in the upright position?

  • Are fuels hoses maintained in a good state of repair?

  • Are flash back arrestors fitted at both the hand piece and gauges?

  • Is an appropriate Fire Extinguisher in place/charge/inspected for current period?

  • Is a Fire Watch in place

  • Have combustibles/flammables been removed from the immediate work area?

  • Have precautions been taken to protect adjacent services from sparks etc?

  • For hot work at height have the appropriate controls been implemented to prevent inadvertent entry to the area?

  • Is there a register for Oxy-Fuel Gas equipment and has it been inspected quarterly?

HOT WORKS PERMITS

  • Is there a Hot Work Permit approved by a Responsible Officer for the work to be carried out?

  • Is the Permit the correct type for the area of work, i.e. Class A, Class B?

  • Has a gas test been performed where required?

  • Have potential fire hazards within 15m been removed or adequately controlled?

  • Is an appropriate fire extinguisher in place/charged/inspected for current period?

  • Is the Fire Watch and Hot Work workgroup wear flame resistant Hi-Vis clothing?

  • Does the Fire Watch have a suitable means of reporting an emergency?

  • Is the Fire Watch attentive to the task?

  • Has the equipment being worked on been isolated, purged and tagged out where required?

  • Have controls been put into place to prevent sparks, slag, off cuts, hot metal or electrode stubbs lodging in places likely to cause a fire or fall to lower level?

ELEVATED WORK PLATFORM (EWP)

  • Has the plant log book been completed?

  • Is a copy of the operator's manual maintained with the machine?

  • Is the EWP free from defect likely to affect the integrity of the machines operation?

  • Are operating controls legible and safety devices in an operable condition?

  • Is the self closing mechanism on the gate in a functional condition?

  • Is the EWP being operated in a safe manner, i.e. proximity to adjacent service, rail, pipe racks, cables, line of fire?

  • Is the operator appropriately secured within the basket and correct PPE work for the task?

  • Has a Spotter/Escort been provided and is within sight of the operation of the machine?

  • Is the Spotter competent in the operation of the machine and familiar with the emergency ground controls?

  • Have adequate precautions such as flagging, cones or warning signs been erected to show hazards?

  • Has bonding been provided between the machine and adjacent structure in the case of electrical welding work?

  • Is a Permit displayed on the machine for exiting the platform in an elevated position?

CONFINED SPACES

  • Is the Permit currently valid for the Confined Space workspace?

  • Permit requirements complied with - access, gas monitoring, isolation, housekeeping, ventilation etc?

  • Confined space entry procedure is attached to permit with any additional JSEA, MSDS attached to permit and complied with?

  • Communications in place, suitable and understood by workforce?

  • JSEA accounts for daily conditions and change management process?

  • Access and Egress - internal & external conducive to safe entry & exit?

  • Pre-entry briefing was conducted and sign-off completed?

  • Emergency evacuation plan in place and understood by workforce?

  • Entry & Stand-by personnel are competent and they understand their responsibilities?

  • Entry Leader identified and understands responsibilities?

  • Correct signage and barriers are in place "No Unauthorised Access", "Confined Space - No Unauthorised Entry"?

  • Personal Locks and Danger Tags attached to hasp at permit?

  • Emergency lighting is intrinsically safe, installed and functional?

  • Fire extinguishers and First Aid Kits are near the access point?

LIFTING & RIGGING

  • Equipment free from defect - indicating that operator has performed a pre-use inspection?

  • Lifting gear is appropriately stored when not in use?

  • Risk assessment in place for use of synthetic slings with a focus on preventing shearing of slings?

  • Is lifting equipment double wrapped on steel components?

  • SWL/Capacity Tags/Ratings and Info on lift equipment legible?

  • Are sharp edges protected?

  • Is the correct equipment being utilised for the task?

  • Are operators performing works in such a manner as to minimise Line of Fire events?

  • 16mm Tag Lines used to control inadvertent load shift?

  • Barricading/cones in place to define lift and slew radius?

  • Are secondary slings being utilised to support unattended suspended loads?

  • Is there a register that includes this equipment, has it been quarterly inspected?

OBSERVER/AUDITOR DETAILS

  • Name and Company

  • Signature

FOR138-Observation Checklist Form (SafetyCulture Version Rev 01)
David Hardman

FOR138-Observation Checklist Form (SafetyCulture Version Rev 01)

Observation Checklist Form - SafetyCulture Version Rev 01

Use this Template
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.

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