• Operator Observed:

  • System:

  • Task being completed by the operator

  • Prepared by

  • Select date

Works Assessment

Section 1: PPE & Workwear

  • Can the employee explain correctly "What PPE they should be wearing in this location"

  • Observation - Is operator wearing correct PPE [head to toe check?] & is it in good condition

Section 2: Accidents & First-Aid

  • Can the employees correctly describe what initial actions they should take in the event of an accident and do they know where the fire assembly point is?

  • Can the employee correctly describe who are the first aiders in the area

Section 3: Competency & Training

  • Has the employee received all the necessary training to complete the tasks they are expected to carry out

  • Are there any recommendations for further training?

Section 4: Working Practice

  • Observation - Is employee paying due care & attention whilst carrying out the task?

  • Observation - Is the employee working safely and not posing a risk to themselves or others


  • Detail any follow up action required and who is responsible for carrying it out here:

  • Unit Leader

  • Operative


  • Any other considerations / comments

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.