HSE Observation

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

General Information

• Time Begun

  Date

• Today's Date

  Date
• Location
  Address

• Site Code

• Service Code

• Subcontractor

  Yes

  No

• Subcontractor

  Off

  On

• Task Observed

• Observer

Observations

People/Protection

• Inducted/Trained

  Yes

  No

  N/A

• PPE Appropriate

  Yes

  No

  N/A

• 'Line of Fire' Hazard

  Yes

  No

  N/A

• Fatigue/Heat Stress

  Yes

  No

  N/A

• Manual Handling

  Yes

  No

  N/A

• Traffic Management

  Yes

  No

  N/A

Places

• General Housekeeping

  Yes

  No

  N/A

• Spills/Leaks/Bunds/Drains

  Yes

  No

  N/A

• Chemical Management

  Yes

  No

  N/A

• Environmental/Weather Hazards

  Yes

  No

  N/A

• Conservation of Water/Power

  Yes

  No

  N/A

• Risk of Falling Objects

  Yes

  No

  N/A

Plant

• Tools/Plant Condition

  Yes

  No

  N/A

• Tools Right for Task

  Yes

  No

  N/A

• Plant Logbooks

  Yes

  No

  N/A

• Safe Access and Egress

  Yes

  No

  N/A

• Electrical Test and Tag

  Yes

  No

  N/A

• Barricades Appropriate

  Yes

  No

  N/A

• Fire Safety Considered

  Yes

  No

  N/A

• First Aid Appropriate

  Yes

  No

  N/A

Process

• Job Start Done

  Yes

  No

  N/A

• Job Analysis Appropriate

  Yes

  No

  N/A

• Procedure Compliance

  Yes

  No

  N/A

• Isolations in Workplace

  Yes

  No

  N/A

• Valid Permit to Work

  Yes

  No

  N/A

• Communications Process

  Yes

  No

  N/A

• Signage

  Yes

  No

  N/A

• Out of Service Tags

  Yes

  No

  N/A

At Risk Behaviour Observations

• Description of At Risk Behaviour

• Rectified?

  Yes

  No

• Escalate?

  Yes

  No

• Description of At Risk Behaviour

• Rectified?

  Yes

  No

• Escalate?

  Yes

  No

Positive Observations

• Description of Positive Behaviour

• Crew Acknowledged?

  Yes

  No

Summary

• Any Other Conments

• Photo

  Media

• Signature

  Sign

• Time Finished

  Date