• Document No.

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Job Observed:

Key Behaviours

  • Standards - complying with standards. (Procedures, rules etc) - Work permits used when needed - No SOP - JSA used - Lock-out, tag-out used - Pre-Use Checks completed

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  • Personal Protective Equipment (PPE) - Worn correctly at all times (includes gloves, hearing, sun protection and breathing)

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  • Positions of People<br>- can they be struck by, fall to/from slip, trip<br>- can they be slaughter in/on between<br>- are they visible to others<br>- appropriate actions for temperature extremes<br>- using good ergonomics<br>- three point hold on ingress/egress - Ladders, cabs etc<br>

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  • Housekeeping, Tools & Equipment<br>- appropriate waste disposal, no spillage visible<br>- appropriate equipment and chemical storage<br>- no tramp material<br>- Tools and equipment in good condition<br>- right tools used correctly

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  • Driving<br>- seat belts always worn<br>- Driving to conditions, road regulations followed<br>- lights/ flags/horn used<br>- licenses current<br>

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  • Chemicals<br>- signage followed, correct and in good condition<br>- correct handling equipment/method<br>- appropriate segregation/separation<br>- aware of inhalation/absorption/ ingestion hazards

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Observed safe or unsafe actions discussed?

Further Actions

  • Discuss with Operator

  • Discuss with Supervisor

  • Raise an Incident Report (SHAERS)

  • Discuss at toolbox meeting

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