Hennie's Mining PTO

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Task(s) Observed

• 1) New worker?

• 2) Poor performer?

• 3) Risk taker?

• 4) Worker with known problem?

• 5) Good performer?

• 6) Routine Observation?

• 7) Incident (Injury / Damage)?

• 8) Incident (Environmental)?

Person(s) Observed

Evaluation

• 1) Recognised all hazard (HSEC)?

  Yes

  No

  N/A

• 2) Used correct tools?

  Yes

  No

  N/A

• 3) Used correct PPE?

  Yes

  No

  N/A

• 4) Workplace safe and pollution free?

  Yes

  No

  N/A

• 5) HSE aspect of workers and environment considered?

  Yes

  No

  N/A

• 6) Maintained good housekeeping throughout the task?

  Yes

  No

  N/A

• 7) Safe and logical steps followed?

  Yes

  No

  N/A

General Comment on Observation

• Photos

  Media

Recommendations

• 1) Is there a current procedure in place for this task?

  Yes

  No

  N/A

• 2) Is current procedure sufficient for this task?

  Yes

  No

  N/A

• 3) Are current tools and equipment performing well for this task?

  Yes

  No

  N/A

• 4) Are the layout of equipment or workstation favourable?

  Yes

  No

  N/A

• 5) Are the current HSE rule sufficient?

  Yes

  No

  N/A

• 6)Training and induction of worker adequate?

  Yes

  No

  N/A

• 7) Is there a ergonomic study in place for this specific task (if not can it continue without)?

  Yes

  No

  N/A

• 8) Can the worker continue performing this task?

  Yes

  No

  N/A

• 9) Observation discussed with relevant parties?

  Yes

  No

  N/A

Signatures

• Observer

  Sign

• Observed party representative

  Sign