Observation

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

General Details

• Name of Employee

• Employee No

• LFL Employee

• Agency Employee

• Signature of Employee. (To be signed after de-brief)

  Sign

• Signature of observer

  Sign

Genera Behavior

• Adhering to site rules/work instructions

  Safe

  At Risk

  N/A

• Adhering to housekeeping standards

  Safe

  At Risk

  N/A

• Using pedestrian walkways

  Safe

  At Risk

  N/A

• Behaving safely

  Safe

  At Risk

  N/A

Manual Handling

• Handling Technique

  Safe

  At Risk

  N/A

• Application of training

  Safe

  At Risk

  N/A

• Appropriate use of handling equipment

  Safe

  At Risk

  N/A

Materials Handling Equipment

• Correct selection of MHE for the task

  Safe

  At Risk

  N/A

• Correct use of MHE

  Safe

  At Risk

  N/A

• Safe speed for conditions

  Safe

  At Risk

  N/A

• Seat belt

  Safe

  At Risk

  N/A

• Alerting pedestrians to presence

  Safe

  At Risk

  N/A

• Use of safety routes

  Safe

  At Risk

  N/A

• Condition of MHE

  Safe

  At Risk

  N/A

Equipment and Tools

• Choosing right equipment for task

  Safe

  At Risk

  N/A

• Using equipment appropriately

  Safe

  At Risk

  N/A

• Condition of equipment

  Safe

  At Risk

  N/A

Personal Protective Equipment (PPE)

• Correct selection of PPE

  Safe

  At Risk

  N/A

• Wearing appropriate PPE

  Safe

  At Risk

  N/A

• Wearing head protection

  Safe

  At Risk

  N/A

• Wearing eye protection

  Safe

  At Risk

  N/A

• Wearing gloves

  Safe

  At Risk

  N/A

• Wearing respiratory protection

  Safe

  At Risk

  N/A

• Wearing safety footwear

  Safe

  At Risk

  N/A

• Wearing Hi Vis

  Safe

  At Risk

  N/A

• Condition of PPE

  Safe

  At Risk

  N/A

Site Specific Observations

• Insert question

• Was question answered correctly?

  at risk

  not at risk

• Insert question

• Was question answered correctly?

  at risk

  not at risk

• Insert question

• Was question answered correctly

  at risk

  not at risk

Basic Cause

• Custom and Practice

  Yes

  No

  N/A

• Direct Instruction

  Yes

  No

  N/A

• Equipment not available

  Yes

  No

  N/A

• Equipment not suitable

  Yes

  No

  N/A

• Failure to follow procedure

  Yes

  No

  N/A

• Horseplay

  Yes

  No

  N/A

Summary of Observation Conversation

• Praise given

  Yes

  No

  N/A

• Feedback Poitive

  Yes

  No

  N/A