Siemens -Safety Conversation Record

• Observation title (optional)

• Observation number (optional)

• Client / Site - (can use locator to specify)

• Conducted on

  Date

• Prepared by: NAME : Employee No. (Optional)

• Location
  Address

Introduction - Make it POSITIVE.

• Ensure that you introduce yourself. Confirm whether the person has time to stop the task and have a conversation.
  Is it safe to stop work?
  This is your chance to build rapport.

• Ask the person if they can take the time to assist you.

  YES they do have time

  NO they do not have time

  Can you come back later?

• Details of person/s you are engaging with.

• Name/s:

• Job title:

FOCUS UPON RISKS - a chance to share a story/experience that relates to this task.

• 

• THINKING ABOUT THE TASK - What are the risks or hazards that this task exposes a person to? Use open ended questions to clarify task and gain understanding.

  Select Contractors/visitors to site Confined Space/Excavations Enviro- weather/UV etc. Environmental (work areas) spills Emergency preparedness Hazardous & Dangerous goods Electricity Fatigue & Work in Isolation Machinery- lathes/cranes Manual Handling/Ergonomics Mobile Plant/FLT's/Cranes Motor Vehicles Powered tools &equipment Slips & Trips Work at Height and falling objects

  • Contractors/visitors to site
  • Confined Space/Excavations
  • Enviro- weather/UV etc.
  • Environmental (work areas) spills
  • Emergency preparedness
  • Hazardous & Dangerous goods
  • Electricity
  • Fatigue & Work in Isolation
  • Machinery- lathes/cranes
  • Manual Handling/Ergonomics
  • Mobile Plant/FLT's/Cranes
  • Motor Vehicles
  • Powered tools &equipment
  • Slips & Trips
  • Work at Height and falling objects

• Add a photo of the site/task if you wish.......

  Media

• ASK - if something went wrong with this task, what could happen as a result?

  Select first aid injury medical treatment lost time injury disabling injury fatality

  • first aid injury
  • medical treatment
  • lost time injury
  • disabling injury
  • fatality

• ASK - Where have you heard of this scenario actually happening?

  Select Never heard of it happening Overseas Somewhere in Australia Somewhere in my state Somewhere in Siemens Somewhere close to here

  • Never heard of it happening
  • Overseas
  • Somewhere in Australia
  • Somewhere in my state
  • Somewhere in Siemens
  • Somewhere close to here

• ASK -What are the main controls in place to reduce the risk of this scenario actually occurring?

• Are the controls effective? If not, describe how they might be improved?

  Yes

  No

  N/A

Get commitment for future behaviour or rectify an unsafe condition.

• ASK - Are there are any other safety issues concerning you or your team? Please note the main points below.

  yes

  no

• Did you identify any other safety hazards at this site?

  yes, it's in SEQuIS or with resp. person

  no

• Ensure that you gain commitment for future safe behaviour if you have observed an unsafe behaviour or condition. Please also ensure that you provide feedback to the person's manager regarding any unsafe behaviours observed.

  Select gained future safe behaviour ensured unsafe condition rectified unsafe behaviour reported to resp. manager

  • gained future safe behaviour
  • ensured unsafe condition rectified
  • unsafe behaviour reported to resp. manager

Thank the person for their time and effort

• Have you thanked the person for their time today?

  yes...... We'll done

  no.... please do so NOW

• Please click the "sign here" button at right and initial.

  Sign

RECORD your Conversation

• NOW EMAIL THE SAFETY CONVERSATION BY:

• Clicking "Export"

• Clicking "Preview " and checking that everything is ok.

• Clicking "Send" and the email address Richard.spence@siemens.com should populate then hit "SEND" and you are finished.