Information
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Document No.
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
Job Observed:
Key Behaviours
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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
- Safe
- Unsafe
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Add media
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Personal Protective Equipment (PPE) - Worn correctly at all times (includes gloves, hearing, sun protection and breathing)
- Safe
- Unsafe
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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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Add media
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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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Add media
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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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Add media
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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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Add media
Observed safe or unsafe actions discussed?
Further Actions
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Discuss with Operator
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Discuss with Supervisor
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Raise an Incident Report (SHAERS)
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Discuss at toolbox meeting
