Hennie's Mining Safe Act Observation

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Part A - Task being observed

Observation Team Members

Location

Time of observation

Safe Act Observation Checklist

Risk Assessment

• Risk assessment required and completed?

  Safe

  At Risk

  N/A

• Risk assessment followed if required?

  Safe

  At Risk

  N/A

• Required permits in place?

  Safe

  At Risk

  N/A

Housekeeping

• Passageways clear of fire hazards?

  Safe

  At Risk

  N/A

• Area free from possible trips / slip hazards?

  Safe

  At Risk

  N/A

• Area free of rubbish?

  Safe

  At Risk

  N/A

Driving

• Seat belts worn?

  Safe

  At Risk

  N/A

• Driving regulations / condition compliance?

  Safe

  At Risk

  N/A

• Correct license / permit?

  Safe

  At Risk

  N/A

• Pre-start check / vehicle condition?

  Safe

  At Risk

  N/A

Tools & Equipment

• Right Tools?

  Safe

  At Risk

  N/A

• Condition & Use?

  Safe

  At Risk

  N/A

• MSDS required & approved?

  Safe

  At Risk

  N/A

• Correct slings used?

  Safe

  At Risk

  N/A

• Correct harness / lanyard used?

  Safe

  At Risk

  N/A

Personal Protective Equipment

• Hard hats / bump caps?

  Safe

  At Risk

  N/A

• Safety glasses?

  Safe

  At Risk

  N/A

• High visual vest / shirt?

  Safe

  At Risk

  N/A

• Safety shoes?

  Safe

  At Risk

  N/A

• Task specific PPE (Respirators / gloves / dust masks)?

  Safe

  At Risk

  N/A

Isolation & Tagging

• Positive Isolation?

  Safe

  At Risk

  N/A

• Lock-out tags in place?

  Safe

  At Risk

  N/A

People Positions

• Barricades in place?

  Safe

  At Risk

  N/A

• Access control?

  Safe

  At Risk

  N/A

• Safe positions in work area (stand-off distances)?

  Safe

  At Risk

  N/A

Procedure Compliance

• Procedure adequate?

  Safe

  At Risk

  N/A

• Procedure understood & followed?

  Safe

  At Risk

  N/A

Environment

• Are all waste disposed correctly?

  Safe

  At Risk

  N/A

• Adequate dust suppression?

  Safe

  At Risk

  N/A

Part B - Corrective action

• Unsafe condition / behaviour corrected?

  Yes

  No

  N/A

Corrective Action

Part C - Personnel Involved

• Discussions held with responsible person(s)?

  Yes

  No

  N/A