Title Page
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Site conducted
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Conducted on
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Prepared by
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Location
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Task Observation Location:
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Date:
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Date:
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Time Observation took:
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Operators Name:
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Operators Title:
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Operators Signature:
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National ID/Iqama Number:
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Operators Name:
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Operators Title:
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Operators Signature:
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National ID/Iqama Number:
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Observers Name:
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Observers Title:
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Observers Signature:
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Time on Present Task:
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Time on Present Task:
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Told in advance
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Notification
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Not told in advance
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Told in advance
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Notification
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Not told in advance
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Reason for Observation
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Practical Assessment
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Substandard performance
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Incident Followup
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Task Observation
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Other (please specify)
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Training Followup
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Practical Assessment
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Reason for Observation
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Substandard performance
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Incident Followup
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Task Observation
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Training Followup
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Other (please specify)
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Element 1: Observation Only Required
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Element 1: Observation Only Required
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Item
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Principle Hazard
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Compliance
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Action Required
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Item
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Has the correct PPE for the task (Fire Resistant Clothing if performing electrical Isolation)
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Has the correct Documentation to perform the Isolation
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Assesses work area for potential hazards
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Isolation Equipment
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Performs Isolation
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Discuss job hazards with others required to isolate
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Communicates the de-isolation to the team
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Correctly de-isolates plant and equipment
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Informs Permit Issuer that the task has been completed
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Element 2: Interaction with the Operator
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Element 2: Interaction with the Operator
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Item
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Questions
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Answers
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Action Required
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What do you do in the event of an emergency in your area?
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Stop work
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Inform workforce to make their way to the nearest Muster point/refuge Chamber
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Take permits to Muster point/refuge chamber and conducts head count
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Conduct head count and remain until all clear is given
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What do you do if someone is working on a task and has not signed on or tagged onto the job?
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Stop the job Immediately
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Inform their immediate Supervisor of the Isolation Breach
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Discuss with team for allowing the person to work without locking and signing on
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Complete an incident report
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How often must you attend refresher training as an Authorised Isolation Officer?
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Annual Refresher
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What is your responsibility if the job continues onto the next shift as an Isolation officer
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Ensure that all personnel have removed their personal danger tags and lock
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Remove my personal danger tag and lock
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Ensure all personnel have signed off on the permit
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Hand over to the incoming isolation officer at the workplace
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Issue the isolation lock key to the new isolation officer
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Ensure that all personnel have removed their personal danger tags and lock
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Remove my personal danger tag and lock
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Ensure all personnel have signed off on the permit
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Hand over to the incoming isolation officer at the workplace
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Issue the isolation lock key to the new isolation officer
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When was the last time you completed your working at heights training?
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Task Observers Comments:
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Review
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Element 3:
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If Yes detail
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Could any of the practices or conditions observed result in Property Damage or personal Injury?
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If Yes detail
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Could any of the practices or conditions observed result in Property Damage or personal Injury?
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If No detail
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Were the methods and practices observed the most efficient and productive?
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Did the practices you observed comply with all the applicable standards that exist for this task?
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If No detail
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Describe any practices or conditions related to the items above that deserve commendation or correction
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Describe any practices or conditions related to the items above that deserve commendation or correction
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Has the operator been properly commended and or reinstructed on these observations?
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Has the operator been properly commended and or reinstructed on these observations?
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If Yes see actions above
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Should followup observation of this worker or task be made in the near future?
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Best practices to Observe
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Fatal Prevention Legend
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Hazards- Something that has the potential to cause harm to People, Property, or the Environment. Example- Struck By, Struck Against, Line of fire, can fall, Slip/trip Hazards, can be caught between, protrusion hazards etc
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Risk assessment which is accurate for the task being performed and signed by all participants, permit to work documentation is complete and signed off by all, People following the agreed work method outlined in the JHA. Good Housekeeping standards
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Competence, Capable and controlled- Person has been trained and has been deemed competent to carry out the task
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Operator has a valid TUV certification or similar for the specific task or machine they would operate, Confirmation via the training matrix that the individual training is up to date
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Crane and lifting Activities- Task involves cranes and lifting activities which must be carried out by trained and certified personnel who currently hold a valid TUV certification for this task
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Permit to work documentation is complete including lift plan. Operator and rigger have valid TUV certification, drop zone is barricaded to prevent unauthorised access, Crane has been set up correctly, tag lines on load
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Driving Safely- Tasks involving the operation of a Heavy or Light vehicle
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Operator to have a valid TUV certification and/or site driving permit and the vehicle must meet site standards, Inspection of Prestart checklists, Review training matrix to ensure operators training is up to date Seat belts are being used,
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Hazardous Energy- Involves tasks where there is hazardous energy is present and requires an isolation to take place by an authorised isolation officer. Example - Electrical, Stored, Pneumatic, Hydraulic, Gravitational (Wheel chocks), Radiation, Mechanical, Thermal, Magnetic, and chemical energy sources
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Permit to work documentation is signed off by all personnel, all isolation points are locked, tagged and tested, all personnel have their Personal danger tags and lock at the isolation point, Area Is barricaded to prevent access, Electrical equipment tagged as per quarterly testing schedule
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Confined Space- 4 characteristics of a confined space- potential for high of low oxygen levels or toxic gases, potential for entrapment or engulfment, Limited access one way in, one way out and is not a normal place of work
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Permit to work documentation is signed off by all personnel, Trained Standby person at the entrance point, gas testing results, People understand the rescue plan, barricading to prevent access, ventilation systems, all personnel have locked and tagged on at the isolation point
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Working at heights- all personnel must be trained and deemed competent to work at heights onsite. Examples, working on a scaffold, EWP’s, Ladders etc
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Permit to work documentation is signed off by all personnel, Scaffold tag has been inspected in the last 14 days, PPE has the correct tag as per the site quarterly testing schedule, Operator is 100% always tied off, barricading in place to prevent unauthorised access or people being hit from falling items., Rated anchor points to 2.2 ton or 22Kn
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Ground Conditions- Surface and Underground- a Person must be trained and deemed competent to Scale (underground) or be able to identify the possibility of a ground failure and the safe steps to take to make the area safe,
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Observe good scaling practices (From the top down), Over hanging ground in the Rom Pad stockpiles where people could be struck by falling ground, Excavations the edges are benched or battered, if unable, they are shored up, Excavations over 1.2 mts are confined spaces
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Guarding and Barricading- Where a safety device has been removed and there is a potential for someone to become entangled from rotating machinery, Demarcation of areas where high risk tasks are being performed
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Area is barricaded to prevent unauthorised personnel access were working at heights or cranes and lifting activities are being undertaken, guarding around rotating machinery, Isolation processes in place when removing guards, Open holes have hard barricading if accessible
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Chemical & Hazardous Substances- Dangerous substances which can cause harm to people and the environment
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MSDS sheet is available for the chemical being used, Correct PPE as per MSDS requirements are being used, Correct Storage of the chemical, Spill kits is available, isolation is performed correctly if working on reagent line
