Safety (Safe Act Observation )

• Client / Site

• Prepared by

• Conducted on

  Date
• Location
  Address

• Document No.

• Personnel

• Activity/task

1.0 Documentation i.e. permits, mods, etc.

• 1.1 Permit checked and signed off

  Safe

  At Risk

  N/A

• 1.2 JHA (eg signed and completed)

  Safe

  At Risk

  N/A

• 1.3 Take 5

  Safe

  At Risk

  N/A

• 1.4 Follows written take 5 and JHA

  Safe

  At Risk

  N/A

2.0 Position of people/mobile equipment

• 2.1 Avoid lines of fire (fingers, hands and body)

  Safe

  At Risk

  N/A

• 2.2 Three points of contact when climbing or descending

  Safe

  At Risk

  N/A

• 2.3 Avoid cramped or over extended posture

  Safe

  At Risk

  N/A

3.0 Ergonomics

• 3.1 Bends knees when lifting

  Safe

  At Risk

  N/A

• 3.2 Load close to the body

  Safe

  At Risk

  N/A

• 3.3 Strong spine when lifting

  Safe

  At Risk

  N/A

• 3.4 Turns with feet and not their back

  Safe

  At Risk

  N/A

• 3.5 Lifts with their legs

  Safe

  At Risk

  N/A

• 3.6 Mechanical aids/team lifting

  Safe

  At Risk

  N/A

4.0 Tools and equipment

• 4.1 Correct for task

  Safe

  At Risk

  N/A

• 4.2 Used correctly/safely

  Safe

  At Risk

  N/A

• 4.3 Seat belts

  Safe

  At Risk

  N/A

• 4.4 Per start inspection and completed log book

  Safe

  At Risk

  N/A

• 4.5 Drives to road conditions

  Safe

  At Risk

  N/A

• 4.6 Vehicle parked correctly (reversed/chocked)

  Safe

  At Risk

  N/A

5.0 Housekeeping/area conditions

• 5.1 Work area tidy

  Safe

  At Risk

  N/A

• 5.2 Barricades and signs

  Safe

  At Risk

  N/A

• 5.3 Hazardous materials stored/handled/transported/used/disposed correctly

  Safe

  At Risk

  N/A

6.0 Personal protective equipment (PPE)

• 6.1 Head

  Safe

  At Risk

  N/A

• 6.2 Eye and face

  Safe

  At Risk

  N/A

• 6.3 Hearing

  Safe

  At Risk

  N/A

• 6.4 Respiratory

  Safe

  At Risk

  N/A

• 6.5 Hand

  Safe

  At Risk

  N/A

• 6.6 Sleeves rolled down and fastened

  Safe

  At Risk

  N/A

• 6.7 Foot

  Safe

  At Risk

  N/A

• 6.8 Fall arrest/restraint

  Safe

  At Risk

  N/A

• 6.9 Sun/heat protection

  Safe

  At Risk

  N/A

At risk comments

• What is that at risk behaviour? (number)

• What did the person say when asked why?

• Solution?

• Resolved

  Yes

  No

  N/A

• What did the person say when asked why?

• What is that at risk behaviour? (number)

• Solution?

• Resolved

  Yes

  No

  N/A

• What is that at risk behaviour? (number)

• What did the person say when asked why?

• Solution?

• Resolved

  Yes

  No

  N/A

Positive feedback comments

• Comments

• Add signature

  Sign

Email to site safety department.