Section 1: Observation Report

  • What was the task observed?

  • Observation Category

  • The observed behaviour was:

  • The observed conditions were:

  • What did the observer say? (e.g. questions asked, positive recognition given)

  • What was the worker's response during the interaction?

Section 2: Improvement Actions

  • Are follow up actions required?

  • What follow up actions are required?

  • Who will perform follow up actions?

  • When is the follow up due?

  • Copy of this report will be sent to person identified for follow up action

  • Date follow up action was completed

  • Is a risk assessment required?

Section 3: Safety Interaction Self Assessment

  • Did you have a discussion with people?

  • Did you give positive recognition? (e.g. Working safely, safe behaviour, safe conditions)

  • Did you per-plan the safety interaction?

  • Did you engage people in problem solving?

  • Did you assess the risks and hazards of the work the people were doing?

  • Have you discussed follow up actions with people listed as responsible and set agreed timing for closure?

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