Title Page
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Site / Project
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Conducted on
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SAO Completed by
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Task Performed
SAO
1. Documentation (Risk Assessment, Permits, SDS, Etc)
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1.1 Permit Checked and signed off (if required)
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1.2 SWMS/JHA completed and signed (if required)
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1.3 Personal Risk Assessment undertaken
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1.4 Follows documented controls
2. Isolations
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2.1 Sources of Energy Controlled
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2.2 Attached Lock and Tag to Isolation Points
3. Position of people / mobile plant and equipment
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3.1 Avoids line of fire (fingers, hands, and body)
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3.2 Three points of contact when climbing / descending
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3.3 Avoid cramped or over extended posture
4. Ergonomics
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4.1 Bends knees when lifting
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4.2 Load close to the body
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4.3 Strong spine when lifting
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4.4 Turn with feet and not the back
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4.5 Lift with legs
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4.6 Mechanical aids / team lifts
5. Tools and equipment
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5.1 Correct for task
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5.2 Used correctly / safely
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5.3 Seatbelts used
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5.4 Pre-start inspection and logbook completed
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5.5 Operates to conditions and rules
6. Housekeeping / area conditions
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6.1 Work area tidy
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6.2 Barricades and signs
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6.3 Hazardous Materials Stored / Handled / Transported / Used / Disposed Correctly.
7. Personal protective equipment
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Head
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Eyes and face
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Hearing
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Respiratory
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Hands
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Sleeves rolled down
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Feet
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Fall arrest / restraint
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Sun / heat protection
Comments
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