Task Observation Form

• Observer/s:

• Conducted on

  Date

• Activity Observed:

• Person/s or Contractors Observed:

• Location:
  Address

• Prepared by:

• SHEWMS Ref No:

Notes

• The purpose of the Task Observation is to observe and interact with workers so that hazards and risks associated are highlighted and discussed to prevent injury / illness. Observations should focus on the work methods of the activity and always include a review of the applicable SHEWMS / Risk Assessment. The SHEWMS / Risk Assessment should be specific to the task / activity being performed and effectively control risk associated with the hazards presented with the work. Observations should be focused and of a short duration (approx 20-30 mins). Observers should focus on good practices as well as detecting poor practices and provide comments to reflect this. Stop the job and conduct a discussion with the crew / individual if at risk behaviour or situations are observed. Use mutal discussion to identify appropriate action and gain commitment to change. It is the responsibility of the observer to ensure that prompt follow up actions occur. Enter the Observation into Cintellate as soon as possible with applicable actions from the Observation.

TELECOMMUNICATIONS SAFETY ESSENTIALS

OBSERVATION (MRO) Minimal Risk Behaviour (ARB) At Risk Behaviour (ARS) At Risk Situation

• 1. Electrical Work

  Yes

  No

• 2. Working at Heights

  Yes

  No

• 3. Driver Alertness

  Yes

  No

• 4. Working in the Vicinity of Utility Services

  Yes

  No

• 5. Excavation Works

  Yes

  No

• 6. Working in the Vicinity of Vehicular Traffic

  Yes

  No

• 7. Working in and Around Mobile Plant

  Yes

  No

• 8. Working in Remote or Isolated Locations

  Yes

  No

• 9. Heavy Lifting

  Yes

  No

• 10. Exposure to Asbestos

  Yes

  No

Observations

• Work Methods / SHEWMS (WM)

  (MRO) Minimal Risk Observed

  (ARB) At Risk Behaviour

  (ARS) At Risk Situation)

• SHEWMS / Risk Assessment is available and specific to activity?

  Yes

  No

  N/A

• Mark this a corrective action ?

• Actioned By Who?

• Action By Date

  Date

• SHEWMS / Risk Assessment highlights applicable hazard (Particularly Safety Essentials)?

  Safe

  At Risk

  N/A

• Mark this a corrective action ?

• Actioned By Who?

• Action By Date

  Date

• SHEWMS / Risk Assessment is signed and understood by workers?

  Safe

  At Risk

  N/A

• Mark this a corrective action ?

• Actioned By Who?

• Action By Date

  Date

• SHEWMS / Risk Assessment is effective at reducing risk

  Safe

  At Risk

  N/A

• Mark this a corrective action ?

• Actioned By Who?

• Action By Date

  Date

• SHEWMS / Risk Assessment complies with Safety Essential Requirements

  Safe

  At Risk

  N/A

• Mark this a corrective action ?

• Actioned By Who?

• Action By Date

  Date

• SHEWMS / Risk Assessment are adhered to?

  Safe

  At Risk

  N/A

• Mark this a corrective action ?

• Actioned By Who?

• Action By Date

  Date

• Isolations, Tags, Permits?

  Safe

  At Risk

  N/A

• Mark this a corrective action ?

• Actioned By Who?

• Action By Date

  Date

• Tools appropriate for job, maintained and used correctly?

  Safe

  At Risk

  N/A

• Mark this a corrective action ?

• Actioned By Who?

• Action By Date

  Date

• Personal Protective Equipment (PPE)

  (MRO) Minimal Risk Observed

  (ARB) At Risk Behaviour

  (ARS) At Risk Situation)

Choose Observation Category:

• Eyes and Face

  Safe

  At Risk

  N/A

• Mark this a corrective action ?

• Actioned By Who?

• Action By Date

  Date

• Ears

  Safe

  At Risk

  N/A

• Mark this a corrective action ?

• Actioned By Who?

• Action By Date

  Date

• Feet and Legs

  Safe

  At Risk

  N/A

• Mark this a corrective action ?

• Actioned By Who?

• Action By Date

  Date

• Respiratory

  Safe

  At Risk

  N/A

• Mark this a corrective action ?

• Actioned By Who?

• Action By Date

  Date

• Hands and Arms

  Safe

  At Risk

  N/A

• Mark this a corrective action ?

• Actioned By Who?

• Action By Date

  Date

• Housekeeping (HK)

  (MRO) Minimal Risk Observed

  (ARB) At Risk Behaviour

  (ARS) At Risk Situation)

Choose Observation Category:

• Work area clear of slip and trip hazards?

  Safe

  At Risk

  N/A

• Mark this a corrective action ?

• Actioned By Who?

• Action By Date

  Date

• Storage of equipment and materials adequate?

  Safe

  At Risk

  N/A

• Mark this a corrective action ?

• Actioned By Who?

• Action By Date

  Date

• Registers up to date?

  Safe

  At Risk

  N/A

• Mark this a corrective action ?

• Actioned By Who?

• Action By Date

  Date

• Field Workforce Information Pack available and up to date?

  Safe

  At Risk

  N/A

• Mark this a corrective action ?

• Actioned By Who?

• Action By Date

  Date

• Body Position (BP)

  (MRO) Minimal Risk Observed

  (ARB) At Risk Behaviour

  (ARS) At Risk Situation)

Choose Observation Category:

• Posture?

  Safe

  At Risk

  N/A

• Mark this a corrective action ?

• Actioned By Who?

• Action By Date

  Date

• Repetitive Movements?

  Safe

  At Risk

  N/A

• Mark this a corrective action ?

• Actioned By Who?

• Action By Date

  Date

• Lifting of Objects?

  Safe

  At Risk

  N/A

• Mark this a corrective action ?

• Actioned By Who?

• Action By Date

  Date

• Footing?

  Safe

  At Risk

  N/A

• Mark this a corrective action ?

• Actioned By Who?

• Action By Date

  Date

• Inhaling?

  Safe

  At Risk

  N/A

• Mark this a corrective action ?

• Actioned By Who?

• Action By Date

  Date

• Falling?

  Safe

  At Risk

  N/A

• Mark this a corrective action ?

• Actioned By Who?

• Action By Date

  Date

• Job Focus (JF)

  (MRO) Minimal Risk Observed

  (ARB) At Risk Behaviour

  (ARS) At Risk Situation)

Choose Observation Category:

• Eyes on Task?

  Safe

  At Risk

  N/A

• Mark this a corrective action ?

• Actioned By Who?

• Action By Date

  Date

• Distractions?

  Safe

  At Risk

  N/A

• Mark this a corrective action ?

• Actioned By Who?

• Action By Date

  Date

• Rushing?

  Safe

  At Risk

  N/A

• Mark this a corrective action ?

• Actioned By Who?

• Action By Date

  Date

• Short Cuts?

  Safe

  At Risk

  N/A

• Mark this a corrective action ?

• Actioned By Who?

• Action By Date

  Date

• Improvisation?

  Safe

  At Risk

  N/A

• Mark this a corrective action ?

• Actioned By Who?

• Action By Date

  Date

• Verbal Interaction?

  Safe

  At Risk

  N/A

• Mark this a corrective action ?

• Actioned By Who?

• Action By Date

  Date

• Awareness of others?

  Safe

  At Risk

  N/A

• Mark this a corrective action ?

• Actioned By Who?

• Action By Date

  Date

Observers Signature

• Please sign your name

  Sign