Safety Observation Form - boning room

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

• task Observed: Operators Name:

• Singature:

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Observe the task in conjunction with the task description

• List the correct PPE required for this task; Is the employee wearing the correct PPE?

• Did YOU observe any potential UNSAFE practices? If so, list them here;

• What is the SAFE behavior YOU wish the employee to focus on?

• Does the employee have a clear understanding of how YOU wish them to complete the task SAFELY?

• Has the employee demonstrated the SAFE behavior to YOU? If yes, how was this done?

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Hazards and Risks

• What Sources of Mechanical Hazards (Moving parts, Pinch points) are present while completing this task? Does the employee understand the risks associated with this task?

• Where is the closest Emergency Stop / Isolation Point in relation to this task? Is it clearly labeled / identified?

• Are there any potential Slip / Trip/ Fall hazards in the vicinity of the task workstation (Discuss these with the employee)

Tools and Equipment

• What tools are required for this task?

• Are the tools maintained in good working condition?

Communication

• Have the employee explain to you how to raise a safety issue

  Yes

  No

  N/A

• Are you aware of any near misses?

  Yes

  No

  N/A

• Does the employee have a safety concern with this task? If so, what is it?

  Yes

  No

  N/A

• How did you make this safety interaction a positive experience?

  Yes

  No

  N/A

• Worker / Supervisor: “how can we improve this task”

• Employee Signature:

  Sign