Information
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Safety Observation Title
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Planned / Unplanned
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Asset
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Conducted on
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Prepared by
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Location
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Personnel
1.0 - Ergonomics
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1.1 - Work area design
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1.2 - Repetitive Action
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1.3 - Posture
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1.4 - Manual handling
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1.5 - Driving posture
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1.6 - Prolonged sitting
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1.7 - Excessive Reaching
2.0 - Personal Protective Equipment
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2.1 - Head
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2.2 - Eyes
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2.3 - Face
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2.4 - Ears / Hearing
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2.5 - Hands / Arms
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2.6 - Respiratory System
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2.7 - Body
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2.8 - Legs / Feet
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2.9 - Sun Protection
3.0 - Position of People
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3.1 - Struck by
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3.2 - Striking Against
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3.3 - Caught Between
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3.4 - Falling
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3.5 - Risk or Burn
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3.6 - Electrical Current
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3.7 - Inhaling / Absorbing
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3.8 - Reversing Vehicle
4.0 - Tools & Equipment
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4.1 - Right for the job
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4.2 - Used correctly
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4.3 - In safe condition
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4.4 - Stored correctly
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4.5 - Checked / Tagged / Inspected
5.0 - Procedures
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5.1 - Pre-start used
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5.2 - JSEA / RTHA used and completed
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5.3 - Right for job
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5.4 - Is there a SWM for the job
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5.5 - behavioural variation
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5.6 - Permits in place
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5.7 - Isolations in place
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5.8 - Trained in procedure
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5.9 - Adequate supervision
6.0 - House Keeping
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6.1 - Workplace is orderly
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6.2 - Slip, Trip, Fall
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6.3 - Access / Egress
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6.4 - Protruding objects
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6.5 - Access to emergency equipment
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6.6 - Signage
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6.7 - Correct labelling
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6.8 - Rubbish
Sign Off
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Operational Staff
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Person conducting observation
