Planned Task Observation

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Observations

• Did the person being observed attend the daily pre start meeting?

  Yes

  No

  N/A

• Is the task being conducted covered by a JHA or Procedure?

  Yes

  No

  N/A

• Has the person being observed signed the JHA or Procedure?

  Yes

  No

  N/A

• Has a Take 5 been completed for the task? (if NO, then please detail reasons)

  Yes

  No

  N/A

• Reason for Observation

  Yes

  No

  N/A

• Are all site management rules being complied with during the task? (PPE requirements, traffic management, etc)

  Yes

  No

  N/A

• Does the person being observed have the appropriate competencies required for the task?

  Yes

  No

  N/A

• Has a Pre Start Check been completed for the items of plant being used?

  Yes

  No

  N/A

• Is the working environment safe to complete the task? (bund walls in place, weather conditions, etc)

  Yes

  No

  N/A

• Is adequate communication being used between workers completing the task? (two way radios, visual, etc?)

  Yes

  No

  N/A

Instructions or Advice Provided to Person Being Observed?

• Instructions Provided

• Advice Provided

• Positive Feedback to Observed Person

• Opportunities for Improvement

Signatures

• Person Conducting Observation

  Sign

• Person being Observed

  Sign