Title Page
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ID
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Observer
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Date - Time
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Observee
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Observation Location
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Observation task
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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.)
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Agreement Achieved (is agreement about corrective and preventive actions to prevent same situation happen again.)
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Follow-up Needed* (detail of corrective and preventive actions to prevent same situation happen again.)
Use of PPE and Tools
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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…)
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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
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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.)
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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…)
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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…)
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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;…)
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Follow proper de-energization control (Exposed with hazardous energy without LOTO; not full attendant LOTO lock; No label on LOTO lock…)
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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)
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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;….)
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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…)
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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;…)
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Follow working at height safety practice (wear safety harness; 100% supervision for roof top activities; follow safety requirement in JSA;…)
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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
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Keep proper body position in manual material handling (Working position is uncomfortable; bend the back; carry heavy thing 30kg continuously;…)
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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.)
Comment
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Observer comment
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Obervee comment