Information

  • PTO / CTO Title

  • Document No.

  • Work area

  • Conducted on

  • Prepared by

  • Location
  • Personnel involved:

  • Occupation of the person being assessed:

  • Contractor or sub-contractor involved

Observations

  • Is there a risk assessment for the task being observed?

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

  • Has the person being observed signed the JSA?

  • Is the JSA for the task completed correctly?

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

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

  • Is a work permit required for the task? <br><br>If so, is the permit approved by AVENG?

  • Is all appropriate PPE used as prescribed?<br><br>PPE correctly applied?

  • Is all plant and equipment being used for the task fit for purpose and in a safe and serviceable condition?

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

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

  • Is there any source of energy present, identified and attended to? (Eliminate or Isolate)

  • Is there any training required for the task and is the worker competent to perform the task?

  • Is the four steps to safety applied and was the person observed able to relate to it with regards to the task that is carried out?

  • Is simultaneous operations taking place and have all parties communicated with each other? (Joint operations)

Instructions or Advice Provided to Person Being Observed? GUTS principle applied?

  • Instructions to make the task safer

  • Advice given

  • Positive Feedback to Observed Person

  • Opportunities for Improvement

Deviation Actions

Fatal risk deviations - FRC BECSA

  • FRC 1: Vehicle and mobile equipment

  • FRC 2: Explosives and blasting

  • FRC 3: Ground control

  • FRC 4: Hazardous material

  • FRC 5: Isolation and lock-out

  • FRC 6: Permit to work

  • FRC 7: Working at height

  • FRC 8: Lifting operations

  • FRC 9: Drowning

  • FRC 10: Equipment safe guarding

  • FRC 11: Oxy-fuel gas

  • Others not FRC

Behaviour deviations

  • Checklists completed correctly?

  • Pre-use inspection carried out

  • SOP followed

  • Hazards identified

  • Negligence or in violation

  • Authorised to perform task

  • Licences for the task

  • OEM specifications followed

  • PPE compliant - correct use

  • Safety devices tampered with?

  • Intoxication - drugs and or alcohol

  • Drug test performed

System deviations

  • Checklist completed

  • Risk assessment and or JSA completed

  • MSDS available

  • SOP in place

  • Proof of competency

  • Proof of training

  • Operating outside scope of work

  • Operational requirements specified

  • PPE availability

Equipment deviations

  • Safe access and egress

  • Chemicals controlled effectively

  • Design requirements followed

  • Use of correct tools for the task

  • Electrical equipment safety

  • Engineering changes documented

  • Engineering approval

  • Ergonomics addressed

  • Housekeeping

  • Maintenance

  • Lockout facilities

  • Safety guarding

  • Operating within limits

  • Spillages observed

  • Unsafe acts

  • Unsafe conditions

Signatures

  • Signature of the Observer

  • Signature of the person being observed

  • Signature of the Supervisor / Foreman

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.