Planned Task Observation - Field Leadership

• Audit Title

• Client / Site

• Location
  Address

• Conducted on

  Date

• Prepared by

• INFRASTRUCTURE WEST

Management led

• Signature

  Drawing

PERSONNEL CONTACTED

• 1. Worker observed during field observation

  Yes

  No

  N/A

• Worker's Name:

• Position

• Pre-Start & AOD

  Yes

  No

  N/A

• Take 5 for current task

  Yes

  No

  N/A

• SWMS reviewed and signed

  Yes

  No

  N/A

• Competency (Operator licence, Qualification)

  Yes

  No

  N/A

• VOC completed

  Yes

  No

  N/A

• 2. Worker observed during field observation

  Yes

  No

  N/A

• Worker's Name:

• Position

• Pre-Start & AOD

  Yes

  No

  N/A

• STAR for current task

  Yes

  No

  N/A

• SWMS reviewed and signed

  Yes

  No

  N/A

• Competency (Operator licence, Qualification)

  Yes

  No

  N/A

• VOC completed

  Yes

  No

  N/A

• 3. Worker observed during field observation

  Yes

  No

  N/A

• Worker's Name:

• Position

• Pre-Start & AOD

  Yes

  No

  N/A

• STAR for current task

  Yes

  No

  N/A

• SWMS reviewed and signed

  Yes

  No

  N/A

• Competency (Operator licence, Qualification)

  Yes

  No

  N/A

• VOC completed

  Yes

  No

  N/A

• 4. Worker observed during field observation

  Yes

  No

  N/A

• Worker's Name:

• Position

• Pre-Start & AOD

  Yes

  No

  N/A

• STAR for current task

  Yes

  No

  N/A

• SWMS reviewed and signed

  Yes

  No

  N/A

• Competency (Operator licence, Qualification)

  Yes

  No

  N/A

• VOC completed

  Yes

  No

  N/A

• 5. Worker observed during field observation

  Yes

  No

  N/A

• Worker's Name:

• Position

• Pre-Start & AOD

  Yes

  No

  N/A

• STAR for current task

  Yes

  No

  N/A

• SWMS reviewed and signed

  Yes

  No

  N/A

• Competency (Operator licence, Qualification)

  Yes

  No

  N/A

• VOC completed

  Yes

  No

  N/A

SAFE BEHAVIOURAL OBSERVATIONS & UNSAFE CONDITIONS

• 1. BEHAVIOUR (Choose one)

  Select People Overhead and Underground Services Personal Protective Equipment Isolation, Energy Sources, Guarding Manual Handling Plant & Equipment Plant & Pedestrian Interface Environmental Work Practices Housekeeping Fall Protection Traffic Managment Other:

  • People
  • Overhead and Underground Services
  • Personal Protective Equipment
  • Isolation, Energy Sources, Guarding
  • Manual Handling
  • Plant & Equipment
  • Plant & Pedestrian Interface
  • Environmental
  • Work Practices
  • Housekeeping
  • Fall Protection
  • Traffic Managment
  • Other:

• Details:

  Safe

  At Risk

  N/A

• COMMENTS

• Was the risk controlled?

  Yes

  No

  N/A

• Select Elimination Substitution Isolation Engineering Administration PPE

  • Elimination
  • Substitution
  • Isolation
  • Engineering
  • Administration
  • PPE

• Action taken / Lessons Learned

• 2. BEHAVIOUR (Choose one)

  Select People Overhead and Underground Services Personal Protective Equipment Isolation, Energy Sources, Guarding Manual Handling Plant & Equipment Plant & Pedestrian Interface Environmental Work Practices Housekeeping Fall Protection Traffic Managment Other:

  • People
  • Overhead and Underground Services
  • Personal Protective Equipment
  • Isolation, Energy Sources, Guarding
  • Manual Handling
  • Plant & Equipment
  • Plant & Pedestrian Interface
  • Environmental
  • Work Practices
  • Housekeeping
  • Fall Protection
  • Traffic Managment
  • Other:

• Details:

  Safe

  At Risk

  N/A

• COMMENTS

• Was the risk controlled?

  Yes

  No

  N/A

• Select Elimination Substitution Isolation Engineering Administration PPE

  • Elimination
  • Substitution
  • Isolation
  • Engineering
  • Administration
  • PPE

• Action taken / Lessons Learned

• 3. BEHAVIOUR (Choose one)

  Select People Overhead and Underground Services Personal Protective Equipment Isolation, Energy Sources, Guarding Manual Handling Plant & Equipment Plant & Pedestrian Interface Environmental Work Practices Housekeeping Fall Protection Traffic Managment Other:

  • People
  • Overhead and Underground Services
  • Personal Protective Equipment
  • Isolation, Energy Sources, Guarding
  • Manual Handling
  • Plant & Equipment
  • Plant & Pedestrian Interface
  • Environmental
  • Work Practices
  • Housekeeping
  • Fall Protection
  • Traffic Managment
  • Other:

• Details:

  Safe

  At Risk

  N/A

• COMMENTS

• Was the risk controlled?

  Yes

  No

  N/A

• Select Elimination Substitution Isolation Engineering Administration PPE

  • Elimination
  • Substitution
  • Isolation
  • Engineering
  • Administration
  • PPE

• Action taken / Lessons Learned

• 4. BEHAVIOUR (Choose one)

  Select People Overhead and Underground Services Personal Protective Equipment Isolation, Energy Sources, Guarding Manual Handling Plant & Equipment Plant & Pedestrian Interface Environmental Work Practices Housekeeping Fall Protection Traffic Managment Other:

  • People
  • Overhead and Underground Services
  • Personal Protective Equipment
  • Isolation, Energy Sources, Guarding
  • Manual Handling
  • Plant & Equipment
  • Plant & Pedestrian Interface
  • Environmental
  • Work Practices
  • Housekeeping
  • Fall Protection
  • Traffic Managment
  • Other:

• Details:

  Safe

  At Risk

  N/A

• COMMENTS

• Was the risk controlled?

  Yes

  No

  N/A

• Select Elimination Substitution Isolation Engineering Administration PPE

  • Elimination
  • Substitution
  • Isolation
  • Engineering
  • Administration
  • PPE

• Action taken / Lessons Learned

• 5. BEHAVIOUR (Choose one)

  Select People Overhead and Underground Services Personal Protective Equipment Isolation, Energy Sources, Guarding Manual Handling Plant & Equipment Plant & Pedestrian Interface Environmental Work Practices Housekeeping Fall Protection Traffic Managment Other:

  • People
  • Overhead and Underground Services
  • Personal Protective Equipment
  • Isolation, Energy Sources, Guarding
  • Manual Handling
  • Plant & Equipment
  • Plant & Pedestrian Interface
  • Environmental
  • Work Practices
  • Housekeeping
  • Fall Protection
  • Traffic Managment
  • Other:

• Details:

  Safe

  At Risk

  N/A

• COMMENTS

• Was the risk controlled?

  Yes

  No

  N/A

• Select Elimination Substitution Isolation Engineering Administration PPE

  • Elimination
  • Substitution
  • Isolation
  • Engineering
  • Administration
  • PPE

• Action taken / Lessons Learned

EQUIPMENT

• 1. Equipment Type & Identification:

• Plant Risk Assessment

  Yes

  No

  N/A

• Test & Tag / Maintenance in date:

  Yes

  No

  N/A

• Pre-Start completed?

  Yes

  No

  N/A

• 2. Equipment Type & Identification:

• Plant Risk Assessment

  Yes

  No

  N/A

• Test & Tag / Maintenance in date:

  Yes

  No

  N/A

• Pre-Start completed?

  Yes

  No

  N/A

• 3. Equipment Type & Identification:

• Plant Risk Assessment

  Yes

  No

  N/A

• Test & Tag / Maintenance in date:

  Yes

  No

  N/A

• Pre-Start completed?

  Yes

  No

  N/A

HAZARDOUS SUBSTANCE REVIEW

• 1. Product Name:

• Identified Hazards of product:

• SDS available

  Yes

  No

  N/A

• Product on SDS Register

  Yes

  No

  N/A

• Correct PPE available & worn by Worker

  Yes

  No

  N/A

• 2. Product Name:

• Identified Hazards of product:

• SDS available

  Yes

  No

  N/A

• Product on SDS Register

  Yes

  No

  N/A

• Correct PPE available & worn by Worker

  Yes

  No

  N/A

• 3. Product Name:

• Identified Hazards of product:

• SDS available

  Yes

  No

  N/A

• Product on SDS Register

  Yes

  No

  N/A

• Correct PPE available & worn by Worker

  Yes

  No

  N/A

ASSESS THE RISK

• What would a reasonably foreseeable outcome be if an incident occurred?

• Consequence

  1 Low

  2 Minor

  3 Moderate

  4 Major

  5 Catastrophic

• Likelihood<br>

  A Almost Certain

  B Likely

  C Possible

  D Unlikely

  E Rare

• Risk Rating

  Low

  Medium

  High

  Extreme

CONTROL THE RISK

• Was the risk controlled?

  Yes

  No

  N/A

• Select Elimination Substitution Isolation Engineering Administration PPE

  • Elimination
  • Substitution
  • Isolation
  • Engineering
  • Administration
  • PPE

• Action taken / Lessons Learned

OBSERVER'S DETAILS

• Name of person reporting this event:

  Sign

• Enter Position

  Select Project Manager Project Superintendent Safety Manager Safety Advisor Engineer Supervisor Leading Hand Employee Contractor

  • Project Manager
  • Project Superintendent
  • Safety Manager
  • Safety Advisor
  • Engineer
  • Supervisor
  • Leading Hand
  • Employee
  • Contractor

• Enter names of personnel contacted during this activity

• Please complete section below and highlight any additional observations and actions

• Please add photo if required

  Media

• Please sketch diagram if required

  Drawing

APPROVAL / MANAGEMENT REVIEW

• Manager to review & approve, or send for further investigation:

  Approved

  Further Action required

• Additional actions and Learnings shared

• Management Approval:

  Sign

• Distribution: (1) Project Manager (2) ZH Administrator (3) Zero Harm Advisor