Information
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Prepared by
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Conducted on
Safety Observation
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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
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Name of observer/s
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Location of observation
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Task observed (e.g. RBT, Search Warrant, Operation, etc)
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Photographs of activity
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Manager/supervisor of staff being observed
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No of workers being observed
Category A – Worker Activity
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Planned or reviewed tasks before commencing the activity<br>
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Supervised the activity<br>
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Conducted operational and safety risk assessments <br>
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SWIs / SOPs / Operational orders provided / referred for all activities undertaken<br><br>
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Personal Protective Equipment used<br>
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Equipment for task checked <br>
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Signage / warning devices provided / used<br>
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Supervisor safety checks conducted during activity<br>
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Other (specify) <br>
Category B – Opportunities for injury due to site set up
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Strike against objects<br>
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Strikes by moving object (including vehicles)<br>
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Falls, trips and slips on same level<br>
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Falls from height<br>
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Body stressing (repetitive movements)<br>
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Body stressing (single movement)<br>
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Poor housekeeping (untidy, obstructions to pathways, storage etc)<br>
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Tools and equipment<br>
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Contact with chemicals and other substances (e.g. Biological)<br>
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Heat, electricity & other environmental factors (e.g. light / allocated space / workplace layout / dust / fumes / temperature etc.)<br>
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Sound and pressure<br>
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Mental stress
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Other (specify)
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Details of unsafe conditions not rectified on site by end of observation
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Contact manager/supervisor of staff and advise of unsafe conditions to be rectified
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Report prepared by
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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)