SAFETY OBSERVATION

• Site conducted

  Select

• Conducted by:

• Date:

  Date

• Status of Report (Systems Manager use only):

  COMPLETED

  PENDING

KNOWLEDGE OF THE TASK

• What is the worker doing?

• How well does the worker understand the task?

  Very Good Understanding

  Good Understanding

  Average Understanding

  Poorly Understands

  Does not understand

• What did the worker identify that could go wrong?

• Do the workers understand all of the hazards?

  Very Good Understanding

  Good Understanding

  Average Understanding

  Poorly Understands

  Does not understand

• Have all the hazards associated with this task been controlled?

  Yes

  No

  N/A

• What have the workers done to control the hazards?

BEHAVIOURS

• Personal Protective Equipment

  Safe

  Somewhat Safe

  At Risk

  N/A

• Comment on Unsafe Behaviour:

• Body Position / Ergonomics

  Safe

  Somewhat Safe

  At Risk

  N/A

• Comment on Unsafe Behaviour:

• Relevant Procedures / Risk Assessment has been followed

  Yes

  Part

  No

  N/A

• Comment on Unsafe Behaviour:

• Housekeeping in work area:

  Safe

  Somewhat Safe

  At Risk

  N/A

• Comment on Unsafe Behaviour:

• Correct Tools and Equipment are being used

  Yes

  Part

  No

  N/A

• Comment on Unsafe Behaviour:

• Do you think it is safe for the workers to continue to do the task?

  Yes

  No

  N/A

• Signature:

  Sign

• IMPORTANT: Stop the task if all of the hazards have not been controlled. Ensure that all of the required controls are in place and effective prior to recommencing work