• Document No.

  • Task Observed

  • Type of Observation

  • Worker

  • Workplace

  • Equipment Used

  • Area Supervisor

  • Observed By

  • Role

  • Conducted on


  • Was We Care Card filled out properly?

  • Does a Policy and/or Procedure exist for this task?

  • Was a copy provided to the worker?

  • If NO, should a procedure be developed?

  • Was the PPE adequate and in conformity with all applicable Policies and Procedures or standards?

  • Was it worn properly?

  • Was a Pre-Op completed and filled out properly?

  • Were all the practices in conformity with all applicable standards for this task?

  • Did the worker perform the task with adequate skills?

  • What is the recommended follow up action?

  • Has there been a Risk Assessment of this job done?

  • Should there be a Risk Assessment done?

Golden Rules

  • Is the worker following all GOLDEN RULES applicable to this task?

  • Driving

  • Ground Stability

  • Lifting, Rigging, and Hoisting

  • Energy Isolation

  • Working at Heights

  • Hazardous Substances

  • Permit to Work

  • Protective Devices & Guarding

  • Personal Protective Equipment

  • Fit for Work


  • Did the worker have any concerns? If YES, please explain.

  • Hazards identified and addressed? If not addressed, explain.

  • Is another Task Observation necessary relatively soon?

  • Describe all conditions or practices that could lead to an accident or material damage:

Review / Sign Off

  • Worker

  • Supervisor

  • Exploration Manager

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.