Onestaff Partial Observation

• Document No.

• Conducted on

  Date

Employee Details

• Employee Name

Client Details

• Company Name

• Address
  Address

• Supervisor on site

Auditor Details

• Select Darryl Blockley Murray Roeske Fiona Ward David Norgate Nick Body Kristan Jellyman John O'Leary

  • Darryl Blockley
  • Murray Roeske
  • Fiona Ward
  • David Norgate
  • Nick Body
  • Kristan Jellyman
  • John O'Leary

Risks

• Is a Hazard Register for the worksite available?

  Yes

  No

  N/A

• Are there any risks that raise concerns by employee or auditor?

  No

  Yes

  n/a

• Is there a Safety Plan or Operating Procedures for the work being conducted?

  Yes

  No

  N/A

• Photo of work area

  Media

Critical Risks

• Are there any risks that require health monitoring (I.e. Noise exceeding TWA 85Db, hazardous chemicals, fumes that are likely to affect health)?

  No

  Yes

  n/a

• Critical Risks identified: working at heights, confined spaces, hazardous chemicals / substances, airborne contaminants etc)?

  No

  Yes

  n/a

• Please specify

  Select Working at Heights Enclosed Spaces Hazardous Substances Hot / Cold Dangerous Equipment Heavy Loads Other

  • Working at Heights
  • Enclosed Spaces
  • Hazardous Substances
  • Hot / Cold
  • Dangerous Equipment
  • Heavy Loads
  • Other

• Comments like

• Follow up action required? If so, by whom?

  No

  Yes

  n/a

• By whom?

  Client

  OneStaff

• A follow up observation required?

  No

  Yes

  n/a

• How many weeks till next scheduled observation?

Observations discussed with site contact

• Observations

• Client Signature

  Sign

• OneStaff Signature

  Sign