Information

  • Prepared by

  • Conducted on

Safety Observation

  • This checklist is used to document the safety observation process as set out in 4.4.5 Safety Observation Procedures & should be completed in conjunction with the procedures.

    One completion of this observation process, provide a copy of the Safety Observation Form to the H&S Committee &/or HSR for the workgroup subject of the observation.

    As you conduct the Safety Observation, communicate and acknowledge positive safety behaviours.

  • Time

  • Name of observer/s

  • Location of observation
  • Task observed (e.g. RBT, Search Warrant, Operation, etc)

  • Photographs of activity

  • Manager/supervisor of staff being observed

  • No of workers being observed

Category A – Worker Activity

  • Planned or reviewed tasks before commencing the activity<br>

  • Supervised the activity<br>

  • Conducted operational and safety risk assessments <br>

  • SWIs / SOPs / Operational orders provided / referred for all activities undertaken<br><br>

  • Personal Protective Equipment used<br>

  • Equipment for task checked <br>

  • Signage / warning devices provided / used<br>

  • Supervisor safety checks conducted during activity<br>

  • Other (specify) <br>

Category B – Opportunities for injury due to site set up

  • Strike against objects<br>

  • Strikes by moving object (including vehicles)<br>

  • Falls, trips and slips on same level<br>

  • Falls from height<br>

  • Body stressing (repetitive movements)<br>

  • Body stressing (single movement)<br>

  • Poor housekeeping (untidy, obstructions to pathways, storage etc)<br>

  • Tools and equipment<br>

  • Contact with chemicals and other substances (e.g. Biological)<br>

  • Heat, electricity & other environmental factors (e.g. light / allocated space / workplace layout / dust / fumes / temperature etc.)<br>

  • Sound and pressure<br>

  • Mental stress

  • Other (specify)

  • Details of unsafe conditions not rectified on site by end of observation

  • Contact manager/supervisor of staff and advise of unsafe conditions to be rectified

  • Report prepared by

  • Document distribution:
    1) Original form to be kept on-site in the audit evidence folder for 5 years
    2) Keep records in accordance with Part 1: The General Retention and Disposal Authority (GA28) - 14.0.0
    Occupational Health And Safety (GA28)

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.