Safe Act Observation Form

• Document No.

• Client / Site

• Conducted on

  Date

• Audit Title

• Prepared by

• Location
  Address

• Personnel

Planning

• Ensure the people are competant to do the task.

  Yes

  No

  N/A

• Inspect the area, tools,and equipment before use.

  Yes

  No

  N/A

• Identify and communicate any hazard or risks to fellow workers.

  Yes

  No

  N/A

• Look at SWP, SWMS or work instruction where available.

  Yes

  No

  N/A

• Undertake a prestart check, hazard ID.

  Yes

  No

  N/A

• Identify permit requirements.

  Yes

  No

  N/A

• MSDS available and awareness of substance to be used.

  Yes

  No

  N/A

• Identify correct tools and equipment to carry out the task at hand.

  Yes

  No

  N/A

Body posture

• Position their body such that they aviod being struck, sprayed, crushed, pinned<br>or in contact with a release of stored energy.

  Yes

  No

  N/A

• Take care in looking where they are moving, walking or driving.

  Yes

  No

  N/A

• Concentrate on the job in hand

  Yes

  No

  N/A

• Consider the general secure layout of the work area.

  Yes

  No

  N/A

Manual handling

• Lift correctly using their legs.

  Yes

  No

  N/A

• Maintain balance, no over stretching or twisting while handling equipment.

  Yes

  No

  N/A

Driving and operating

• Wear seatbelts provided.

  Yes

  No

  N/A

• Drive to the conditions of the roadways.

  Yes

  No

  N/A

• Use the horn. indicators and lights as required.

  Yes

  No

  N/A

• Check to ensure emergency stop switches are working

  Yes

  No

  N/A

Personal Protective clothing and equipment

• In good, clean state of repair.

  Yes

  No

  N/A

• Worn as required and in line with the identified inherant hazards.

  Yes

  No

  N/A

• The correct type for the job at hand.

  Yes

  No

  N/A

Isolation and Tagging.

• Applied positive isolation where required.

  Yes

  No

  N/A

• Applied a danger/out of service tag as required

  Yes

  No

  N/A

• Used barrier tape or physical barriers where required.

  Yes

  No

  N/A

• Used barrier tape or physical barriers where required.

  Yes

  No

  N/A

Additional behaviours to be observed

• Verify adequacy of the pre-start process i.e. how effectively do they induct you onto their site

  Yes

  No

  N/A

• Check the rigour of the risk assessment - have ALL hazards been identified, are the controls adequate - why are they doing the job the way they are doing it?

  Yes

  No

  N/A

• Check the effectiveness of the clarity of communication i.e. who is the 'responsible person' on site - is this clear, is it agreed, is it respected?

  Yes

  No

  N/A

• Confirm compliance with procedures (generally)

  Yes

  No

  N/A

• Check housekeeping of site / state of vehicle

  Yes

  No

  N/A

• Positive feedback given to acceptable actions

• Feedback and action items raised to eliminate at risk behaviours.

• These items should be raised in the next shift meeting

• Signature of observer

  Sign