Life Rules Safety Observation Sheet

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

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• Observe the meeting and effectiveess

  Meeting well run and effective

  Meeting not effective or well run

• safety moment/safety flashes/osh alert communicated effectively

  Yes

  No

  N/A

• SJP documented requested for review

  Yes

  No

  N/A

• Responsible person on site assigned for high risk work

  Yes

  No

  N/A

• High risk activities clearly identified and assigned

  Yes

  No

  N/A

• When speaking to operator (s) how open are they to changing their safety behaviour and are they aware of their safety requirement

  Safe

  At Risk

  N/A

• Did any of the crew change their body position or modify their behavior and work practices because they knew they were being Observed?

  Yes

  No

  N/A

• Did the crew/operator stop what they were Doing?

  Yes

  No

  N/A

• Correct tools are being used for the Job?

  Yes

  No

  N/A

• Is the person competent with the equipment being used and is it being used correctly (e.g. Pda, gas tester, CAT, etc.,)

  Yes

  No

  N/A

• Condition of equipment?

  Good

  Bad

Driving

• Journey planned/discussed with team Leader?

  Yes

  No

  N/A

• Daily vehicle inspection conducted?

  Yes

  No

  N/A

• Mobile phone use in Vehicle?

  Yes

  No

  N/A

• Condition of trailers - checks in Place?

  Yes

  No

  N/A

Safe Job Planing

• Has the appropriate level of SJP been used for this Job?

  Yes

  No

  N/A

• JSEA/Step back

  JSEA

  Step Back

• JSEA or Step Back completed site specific

  Yes

  No

  N/A

• Check sign on by Contractors and Water Corp staff on job, including responsible person on site identified

  Yes

  No

  N/A

• Risk assessment and controls for hazards are in Place?

  Yes

  No

  N/A

• Evidence that planning is reviewed when Job changes

  Yes

  No

  N/A

• What permits are required - are they attached with SJP Document?

  Yes

  No

  N/A

• Is the person conducting the task , the person assigned to the step/Activity?

  Yes

  No

  N/A

Fitness for work

• Has anyone on the site worked more than 12 Hours?

  Yes

  No

  N/A

• Did everyone on site have a 10 hour break before coming to work Today?

  Yes

  No

  N/A

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  Yes

  No

  N/A

• Discuss fatigue management/authorisation where applicable

  Not required

  required

• Drug and alcohol; ask understanding of post positive testing

  understanding clear

  Not understanding

• Operators demonstrate an understanding of working in the heat and being hydrated

  understanding clear

  Not understanding

Traffic Management

• Manager or somebody with Basic Traffic Management Training is on site

  Yes

  No

  N/A

• Traffic management plan is in place and effective

  Yes

  No

  N/A

• Signage etc, is appropriate and complies with the diagram

  Yes

  No

  N/A

• Adequate provision for pedestrians

  Yes

  No

  N/A

Working alone or in isolation

• Understanding of Lone Worker definition and use of LWMS including report back intervals

  Yes

  No

  N/A

• Use of EPERB or PLB

  Yes

  No

  N/A

• Assess Supervisors use of monitoring LWMS

  understanding clear

  Not understanding

• Is local escalation list up to date

  Yes

  No

  N/A

Chlorine Safety

• Training up to date?

  Yes

  No

  N/A

• SCBA checked and in Date?

  Yes

  No

  N/A

• Ammonia Puffer in date (< 90 days old )

  Yes

  No

  N/A

Isolation and Tagging

• Is the Isolation Effective?

  Yes

  No

  N/A

• Correct tags being Used?

  personal danger, isolation, out of service

  Not correctly used

• Training Is current (3 years)

  Yes

  No

  N/A

• Forms used correctly (where required)

  Yes

  No

  N/A

• Lockout device Used?

  Yes

  No

  N/A

Confined Space/Prevention of falls/Working at heights

• POF and/or SCBA training Current?

  current

  Not current

• Required permits in Place?

  Yes

  No

  N/A

• Gas monitors being used and calibrated

  Yes

  No

  N/A

• Understanding of atmospheric gases?

  Yes

  No

  N/A

• Accessing high level Tanks?

  Yes

  No

  N/A

• Using a harness Correctly?

  Yes

  No

  N/A

• Using a tripod/Sala c base/pro man correctly?

  Yes

  No

  N/A

• Rescue plans in place - e.g. is the location and nearest cross road and local hospital phone number filled in, first aider Nominated?

  Yes

  No

  N/A

• Rescue equipment Set up/on site matches the resources required list

  Yes

  No

  N/A

Bridging Cables

• Bridging Cables used where Required?

  Yes

  No

  N/A

• Rubber Gloves/matting in Use?

  Yes

  No

  N/A

Excavations

• Benching/battering > 1.5mtr in Place?

  Yes

  No

  N/A

• Spot at least 600mm from excavation?

  Yes

  No

  N/A

• 1.5 mtr to 6.0 mtr sign off by team Leader?

  Yes

  No

  N/A

• Barricades, deep excavation sign in place?

  Yes

  No

  N/A

• Suitable access and egress

  Yes

  No

  N/A

• Evidence for rescue Planning?

  Yes

  No

  N/A

• PPE in good condition and being worn Properly?

  Yes

  No

  N/A

• PPE fit for Task?

  Yes

  No

  N/A

• Did the person adjust their PPE to comply with safety standards?

  no

  yes

• Are operators aware of line of fire e.g struck by objects, Plant and equipment, Traffic?

  Yes

  No

  N/A

• Are operators actively trying to adapt good manual handling techniqes? Such as kneeling instead of stooping, moving the feet instead of twisting, working closer to the body, asking for assistance when lifting.?

  Yes

  No

  N/A

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