PERSONNEL CONTACTED

  • 1. Worker observed during field observation

  • Worker's Name:

  • Position

  • Pre-Start & AOD

  • Take 5 for current task

  • SWMS reviewed and signed

  • Competency (Operator licence, Qualification)

  • VOC completed

  • 2. Worker observed during field observation

  • Worker's Name:

  • Position

  • Pre-Start & AOD

  • STAR for current task

  • SWMS reviewed and signed

  • Competency (Operator licence, Qualification)

  • VOC completed

  • 3. Worker observed during field observation

  • Worker's Name:

  • Position

  • Pre-Start & AOD

  • STAR for current task

  • SWMS reviewed and signed

  • Competency (Operator licence, Qualification)

  • VOC completed

  • 4. Worker observed during field observation

  • Worker's Name:

  • Position

  • Pre-Start & AOD

  • STAR for current task

  • SWMS reviewed and signed

  • Competency (Operator licence, Qualification)

  • VOC completed

  • 5. Worker observed during field observation

  • Worker's Name:

  • Position

  • Pre-Start & AOD

  • STAR for current task

  • SWMS reviewed and signed

  • Competency (Operator licence, Qualification)

  • VOC completed

SAFE BEHAVIOURAL OBSERVATIONS & UNSAFE CONDITIONS

  • 1. BEHAVIOUR (Choose one)

  • Details:

  • COMMENTS

  • Was the risk controlled?

  • Action taken / Lessons Learned

  • 2. BEHAVIOUR (Choose one)

  • Details:

  • COMMENTS

  • Was the risk controlled?

  • Action taken / Lessons Learned

  • 3. BEHAVIOUR (Choose one)

  • Details:

  • COMMENTS

  • Was the risk controlled?

  • Action taken / Lessons Learned

  • 4. BEHAVIOUR (Choose one)

  • Details:

  • COMMENTS

  • Was the risk controlled?

  • Action taken / Lessons Learned

  • 5. BEHAVIOUR (Choose one)

  • Details:

  • COMMENTS

  • Was the risk controlled?

  • Action taken / Lessons Learned

EQUIPMENT

  • 1. Equipment Type & Identification:

  • Plant Risk Assessment

  • Test & Tag / Maintenance in date:

  • Pre-Start completed?

  • 2. Equipment Type & Identification:

  • Plant Risk Assessment

  • Test & Tag / Maintenance in date:

  • Pre-Start completed?

  • 3. Equipment Type & Identification:

  • Plant Risk Assessment

  • Test & Tag / Maintenance in date:

  • Pre-Start completed?

HAZARDOUS SUBSTANCE REVIEW

  • 1. Product Name:

  • Identified Hazards of product:

  • SDS available

  • Product on SDS Register

  • Correct PPE available & worn by Worker

  • 2. Product Name:

  • Identified Hazards of product:

  • SDS available

  • Product on SDS Register

  • Correct PPE available & worn by Worker

  • 3. Product Name:

  • Identified Hazards of product:

  • SDS available

  • Product on SDS Register

  • Correct PPE available & worn by Worker

ASSESS THE RISK

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

  • Consequence

  • Likelihood

  • Risk Rating

CONTROL THE RISK

  • Was the risk controlled?

  • Action taken / Lessons Learned

OBSERVER'S DETAILS

  • Name of person reporting this event:

  • Enter Position

  • Enter names of personnel contacted during this activity

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

  • Please add photo if required

  • Please sketch diagram if required

APPROVAL / MANAGEMENT REVIEW

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

  • Additional actions and Learnings shared

  • Management Approval:

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

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