General Information

  • Time Begun

  • Today's Date

  • Location
  • Site Code

  • Service Code

  • Subcontractor

  • Subcontractor

  • Task Observed

  • Observer



  • Inducted/Trained

  • PPE Appropriate

  • 'Line of Fire' Hazard

  • Fatigue/Heat Stress

  • Manual Handling

  • Traffic Management


  • General Housekeeping

  • Spills/Leaks/Bunds/Drains

  • Chemical Management

  • Environmental/Weather Hazards

  • Conservation of Water/Power

  • Risk of Falling Objects


  • Tools/Plant Condition

  • Tools Right for Task

  • Plant Logbooks

  • Safe Access and Egress

  • Electrical Test and Tag

  • Barricades Appropriate

  • Fire Safety Considered

  • First Aid Appropriate


  • Job Start Done

  • Job Analysis Appropriate

  • Procedure Compliance

  • Isolations in Workplace

  • Valid Permit to Work

  • Communications Process

  • Signage

  • Out of Service Tags

At Risk Behaviour Observations

  • Description of At Risk Behaviour

  • Rectified?

  • Escalate?

  • Description of At Risk Behaviour

  • Rectified?

  • Escalate?

Positive Observations

  • Description of Positive Behaviour

  • Crew Acknowledged?


  • Any Other Conments

  • Photo

  • Signature

  • Time Finished

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