Title Page
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Task
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Department
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Date and Time
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Conducted By
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Employee Name
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Employee Number
Observation
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Type of observation
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Task performed safely
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Correct Tools Used
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Correct PPE Used
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Workplace/Area safe
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Health and Safety of others considered
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Work oderly and clean
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Hazards and Risks regocnized
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Comments
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Recommendations
Signatories
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Employee Sign
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Observer Sign