Safe Act Observation

• Document No.

• Conducted on

  Date

• SAO performed by:

  Nic Hope

  Dave Wilson

  Adam Brownbill

  Paul Robinson

• Branch:

  Brisbane, Kerry Rd

  Brisbane, Beaudesert Rd

• Department:

  Select CRC CE UE GR HYD TS CCE EA

  • CRC
  • CE
  • UE
  • GR
  • HYD
  • TS
  • CCE
  • EA

• Personnel

• Personnel job title:

  Fitter

  Apprentice

  TA

  Leading Hand

  Supervisor

• Task:

• Job number:

Take5

• Has a Take5 been completed...?

  Yes

  No

  N/A

• Photo of Take5...

  Media

• What risks or hazards were identified and control measures were implemented...?

• Photo's of control measures if required...

  Media

Isolation and Tagging

• Has equipment been correctly isolated...?

  Yes

  No

  N/A

• Photo's of isolation method...

  Media

• Is equipment tagged out with correct danger / under test / information tag and lock...?

  Yes

  No

  N/A

PPE

• Correct PPE being worn for task...?

  Safe

  At Risk

  N/A

Housekeeping

• Is housekeeping acceptable in bay / area...?

  Yes

  No

  N/A

• Photo's of housekeeping if required...

  Media

Signature

• Comments from employee...?

• Signature of auditor

  Sign