Planned Task Observation - Local

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

PentaCon

Person/s Observing:

Person

• Yes

  No

  N/A

• Add signature

  Sign

• Is a Work Procedure Available ( SOP , Site Practice ect )

  yes

  no

• What is the document number or name?

• Is a Work Procedure required for this job

  yes

  no

• Stop job and complete

• What is the document number or name?

• Has a risk assessment been completed?

  yes

  no

• What is the document number or name?

• Do Not Proceed until risk assessment is complete

• Action to be completed by supervisor

  Sign

• Are SLAMS completed

  yes

  no

• Stop Job and Complete

Safe people

• Competence and Knowledge

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Stop job and make safe

• What is the corrective action/s

• Action to be completed by Supervisor

  Sign

• Authorized for site

  Yes

  No

  N/A

• Stop job and make safe

• What is the corrective action/s

• Action to be completed by Supervisor

  Sign

• Operate equipment correctly

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Stop job and make safe

• What is the corrective action/s

• Action to be completed by Supervisor

  Sign

Safe Equipment

• Is the equipment fit for purpose

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Stop job and make safe

• What is the corrective action/s

• Action to be completed by Supervisor

  Sign

• Mobile Equipment

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Stop job and make safe

• What is the corrective action/s

• Action to be completed by Supervisor

  Sign

• Lifting Equipment

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Stop job and make safe

• What is the corrective action/s

• Action to be completed by Supervisor

  Sign

• Electrical Equipment

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Stop job and make safe

• What is the corrective action/s

• Action to be completed by Supervisor

  Sign

• Machine Gaurding

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Stop job and make safe

• What is the corrective action/s

• Action to be completed by Supervisor

  Sign

• Tools suitable for the job

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Stop job and make safe

• What is the corrective action/s

• Action to be completed by Supervisor

  Sign

• Equipment serviceable

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Stop job and make safe

• What is the corrective action/s

• Action to be completed by Supervisor

  Sign

• Access and Egress

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Stop job and make safe

• What is the corrective action/s

• Action to be completed by Supervisor

  Sign

• Protective devices

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Stop job and make safe

• What is the corrective action/s

• Action to be completed by Supervisor

  Sign

Safe Conditions

• Buildings and Structures

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Stop job and make safe

• What is the corrective action/s

• Action to be completed by Supervisor

  Sign

• Areas and Roadways

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Stop job and make safe

• What is the corrective action/s

• Action to be completed by Supervisor

  Sign

• Hygiene

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Stop job and make safe

• What is the corrective action/s

• Action to be completed by Supervisor

  Sign

• Ergonomics

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Stop job and make safe

• What is the corrective action/s

• Action to be completed by Supervisor

  Sign

• Lighting

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Stop job and make safe

• What is the corrective action/s

• Action to be completed by Supervisor

  Sign

• Ventilation

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Stop job and make safe

• What is the corrective action/s

• Action to be completed by Supervisor

  Sign

• House keeping

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Stop job and make safe

• What is the corrective action/s

• Action to be completed by Supervisor

  Sign

• Stacking and Storage

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Stop job and make safe

• What is the corrective action/s

• Action to be completed by Supervisor

  Sign

• Colour Coding

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Stop job and make safe

• What is the corrective action/s

• Action to be completed by Supervisor

  Sign

Safe Methods

• Procedures / Rules Followed

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Stop job and make safe

• What is the corrective action/s

• Action to be completed by Supervisor

  Sign

• Procedures known / not known

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Stop job and make safe

• What is the corrective action/s

• Action to be completed by Supervisor

  Sign

• Procedures adequate for the job

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Stop job and make safe

• What is the corrective action/s

• Action to be completed by Supervisor

  Sign

• Forces or Energy Controlled<br><br><br>

  Yes

  No

  N/A

• Stop job and make safe

• What is the corrective action/s

• Action to be completed by Supervisor

  Sign

• Appropriate Permits in Place

  Yes

  No

  N/A

• What is the permit name / number

• Stop job and make safe

• What is the corrective action/s

• Action to be completed by Supervisor

  Sign

• Correct PPE used

  Yes

  No

  N/A

• Stop job and make safe

• What is the corrective action/s

• Action to be completed by Supervisor

  Sign

• Hazardous Substances

  Yes

  No

  N/A

• Stop job and make safe

• What is the corrective action/s

• Action to be completed by Supervisor

  Sign

Safe Environment

• Dust control

  Yes

  No

  N/A

• Stop job and make safe

• What is the corrective action/s

• Action to be completed by Supervisor

  Sign

• Noise control

  Yes

  No

  N/A

• Stop job and make safe

• What is the corrective action/s

• Action to be completed by Supervisor

  Sign

• Pollution controlled at source

  Yes

  No

  N/A

• Stop job and make safe

• What is the corrective action/s

• Action to be completed by Supervisor

  Sign

• Waste management

  Yes

  No

  N/A

• Stop job and make safe

• What is the corrective action/s

• Action to be completed by Supervisor

  Sign

• Scrap and Refuse

  Yes

  No

  N/A

• Stop job and make safe

• What is the corrective action/s

• Action to be completed by Supervisor

  Sign

• Safe acts

• Unsafe Acts

• N/A

Work Procedure or Training material Review

• Are any changes / modifications required

  Yes

  No

• Provide details of any variations or changes required to formal Work Procedures or Training Material. Please note that a Change Of Management Approval may be required.

• Please give examples of Safe Acts/Conditions observed

Actions and Follow-Up

Action

• Action

• Due date

  Date

• To be completed by

  Sign

• Supervisor sign off

  Sign