Safety Observation

• Prepared by

• Conducted on

  Date

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

  Date

• Name of observer/s

• Location of observation
  Address

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

• Photographs of activity

  Media

• Manager/supervisor of staff being observed

• No of workers being observed

Category A – Worker Activity

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

  Yes

  No

  N/A

• Supervised the activity<br>

  Yes

  No

  N/A

• Conducted operational and safety risk assessments <br>

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Personal Protective Equipment used<br>

  Yes

  No

  N/A

• Equipment for task checked <br>

  Yes

  No

  N/A

• Signage / warning devices provided / used<br>

  Yes

  No

  N/A

• Supervisor safety checks conducted during activity<br>

  Yes

  No

  N/A

• Other (specify) <br>

  Yes

  No

  N/A

Category B – Opportunities for injury due to site set up

• Strike against objects<br>

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Falls from height<br>

  Yes

  No

  N/A

• Body stressing (repetitive movements)<br>

  Yes

  No

  N/A

• Body stressing (single movement)<br>

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Tools and equipment<br>

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Sound and pressure<br>

  Yes

  No

  N/A

• Mental stress

  Yes

  No

  N/A

• Other (specify)

  Yes

  No

  N/A

• 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

  Sign

• 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)