Title Page

  • ID

  • Observer

  • Date - Time

  • Observee

  • Observation Location

  • Observation task

  • Conversation made (Not only an alignment process about safety requirement understanding and safe behaviours thru conversation. But also, the agreement about corrective and preventive action.)

  • Agreement Achieved (is agreement about corrective and preventive actions to prevent same situation happen again.)

  • Follow-up Needed* (detail of corrective and preventive actions to prevent same situation happen again.)

Use of PPE and Tools

  • Use proper PPE (Wear proper ear plug/earmuffin required area; wear hair net cover all hair and ears; wear proper safety shoes and no use broken shoes; wear double landyard harness for roof activities…)

  • Use correct tool for the task (use right capacity load of rope for lifting; use fiberglass ladder for electrical activities; use unti spark tools for maintenance activities…)

Safety Control Practice

  • Identify all hazardous energy sources (Source of electrical, mechanical, hydraulic, pneumatic, chemical, thermal, gravitational, or other energy capable of causing injury or harm to people.)

  • Comply with electrical safety-related work practices (DO NOT working with live source; do not connect with electrical wires/source by yourself, follow electrical safety requirement; trained before working with electrical…)

  • Avoid working, walking or standing under a suspended load ( included loading/unloading activities; underneath SAM/RM liftting area; hanging crain's hook suspending not put on the floor/safe places…)

  • Do NOT override, bypass, remove any guard, safety panel and interlock (bypass interlock safety door without permit; remove guard for moving part; deactivate or cover emergency stop button;…)

  • Follow proper de-energization control (Exposed with hazardous energy without LOTO; not full attendant LOTO lock; No label on LOTO lock…)

  • Comply with hotwork policy and control practices (No permit of hot work; Not full comply with requirement in approved JSA, keep safety distance (11m) with ignition source/flammable materials)

  • Follow proper forklift operating procedure (Wear seat belt; do not lift the goods which block your view; do not carry/lift people; lift over capacity; using cellphone while operating FLT;….)

  • Conducts pre-use equipment checks (Conduct the checking for crane, hoist, FLT, personal lift, A ladder, safety harness before using; ; Do not sue if defects found…)

  • Follow safe procedures when preparing and loading rail-cars and/or trailers (Turn off engine, put the break, wheels chock, handover keys to KC supervisor; apply safety stand with clock if remove prime mover;…)

  • Follow working at height safety practice (wear safety harness; 100% supervision for roof top activities; follow safety requirement in JSA;…)

  • Follow task-specific SOP (base on the specific of task for JSA and permit required; follow work instruction or JSA requirement.)

Body Position and Ergonomics

  • Keep proper body position in manual material handling (Working position is uncomfortable; bend the back; carry heavy thing 30kg continuously;…)

  • Maintains three points of contact when climbing (2 hands and 2 feet are 4 contact points. Always keep atleast 3 points contact when climbing; Do not over reaching or unstable position when climbing.)


  • Observer comment

  • Obervee comment

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