Nitro Safety Job Observation Report

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Task being undertaking during Observation.<br>

  Safe

  At Risk

  N/A

• Was Training provided? If so, what was shown? Who was shown?

  Yes

  No

  N/A

• Was the training understood?<br>

  Yes

  No

  N/A

• Feedback

  Yes

  No

  N/A

• Add media

  Media

• Corrective Actions Needed: Reported to:

• Any compliance or behavioural issues identified that should be entered into the Nitro Incident Report System

• Incident Report No: And Reported to:

• Observer Signature:

  Sign

Standards, Procedures, Work Instructions, JRA:

• Correct SWP or JHA in place

  Yes

  No

  N/A

• All Persons aware

  Yes

  No

  N/A

• SWP followed correctly

  Yes

  No

  N/A

• SWP No's:

Personal Protective Equipment / Clothing:

• Correct type / Appropriate for job

  Yes

  No

  N/A

• Used correctly

  Yes

  No

  N/A

Tools / Equipment used for task:

• Correct type / appropriate for job

  Yes

  No

  N/A

• Tool used correctly

  Yes

  No

  N/A

• In serviceable condition

  Safe

  At Risk

  N/A

General Evaluation:

• Trapped in, on or between moving parts

  Yes

  No

  N/A

• Manual Handing

  Yes

  No

  N/A

• Strain / Over-exertion

  Yes

  No

  N/A

• Constant repetitive actions

  Yes

  No

  N/A

• Contact extreme hot or cold

  Yes

  No

  N/A

• Hazardous substances? MSDS? Storage?

  Yes

  No

  N/A

Housekeeping:

• Area assessed for suitability before start

  Yes

  No

  N/A

• Area kept tidy during the task

  Yes

  No

  N/A

• Area left tidy after task completed <br>

  Yes

  No

  N/A

Isolation / Pre start:

• All isolation points identified

  Yes

  No

  N/A

• Isolation performed correctly

  Yes

  No

  N/A

• Pre starts preformed as required

  Yes

  No

  N/A

• Other: