Information

  • Department

  • Date:

  • Task/ Job Description:

  • Machine/ Equipment number:

  • Document No.

Reason for Observation

  • New Worker

  • Routine Observation

  • Worker with known ability problem

  • Risk Taker

  • Worker received on the job training

  • Unsafe Conditions

  • Incident - Injury

  • Incident - Damage

  • Verify SOP is correct

  • High Risk task

  • Identifying Training Needs

  • Change In process

  • Refresher training

  • On- the - Job training received

  • Other

Observations

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

  • Is the task being conducted covered by a procedure?

  • Has the person being observed trained on the procedure?

  • Required PPE used?

  • Was a Risk Assessment done? (SLAM - STOP, LOOK, ASSESS, MANAGE)

  • Was the risk assessment communicated?

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

  • Where machinery and equipment are used or operated, does the operator or user have a clear and good understanding of the Safe Operating Proccedures/ Safe Work Instructions?

  • Does the operator or user understand the risk and hazards involved in the use or operation of the machine?

  • Does the user or operator understand what to do during an emergency?

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

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

  • Are all E- Stops tested for functionality during the prestart check?

  • Is the working environment safe to complete the task?

  • Is adequate communication being used between workers completing the task?

Additional Hazards Identified?

  • undefined

Instructions or Advice Provided to Person Being Observed?

  • Instructions Provided

  • Advice Provided

  • Positive Feedback to Observed Person

  • Opportunities for Improvement/ Recommendations

Notes

  • undefined

Signatures

  • Person Conducting Observation

  • Person being Observed

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