TS Safety Contact Checklist Seqwater

• TS Safety Contact Checklist

• Observer's Name

• Task being observed

• Conducted on

  Date

• INSTRUCTIONS:
  Introduce yourself
  Tell them you are doing an observation
  Tell them No Name No Blame
  Find a safe place to stand
  Observe for approximately 10 minutes
  Provide feedback, including positive feedback
  Find out Why they behaved at risk
  Finish with summaries of positive behaviour
  Ask for suggestions
  

Body Mechanics

• Lifting

  Safe

  At Risk

  N/A

• Body position

  Safe

  At Risk

  N/A

• Keeping out of pinch points

  Safe

  At Risk

  N/A

• Keeping eyes on job/path

  Safe

  At Risk

  N/A

• Ascending/ descending

  Safe

  At Risk

  N/A

• Record any at risk behaviour

PPE

• Eye and face protection

  Safe

  At Risk

  N/A

• Head protection

  Safe

  At Risk

  N/A

• Hand protection

  Safe

  At Risk

  N/A

• Fall protection

  Safe

  At Risk

  N/A

• Hearing protection

  Safe

  At Risk

  N/A

• Respiratory Protection

  Safe

  At Risk

  N/A

• Body protection

  Safe

  At Risk

  N/A

• Record any at risk behaviour

Job Factors

• Shortcuts/haste

  Safe

  At Risk

  N/A

• Communications

  Safe

  At Risk

  N/A

• Work surfaces

  Safe

  At Risk

  N/A

• Barricading

  Safe

  At Risk

  N/A

• Isolations

  Safe

  At Risk

  N/A

• Record any at risk behaviour

Tools and equipment

• Tool / equipment selection appropriate

  Safe

  At Risk

  N/A

• Tool / equipment use

  Safe

  At Risk

  N/A

• Tool / equipment condition

  Safe

  At Risk

  N/A

• Ladders

  Safe

  At Risk

  N/A

• Record any at risk behaviour

Housekeeping

• Trash / debris

  Safe

  At Risk

  N/A

• Material storage

  Safe

  At Risk

  N/A

• Hoses, cords and leads

  Safe

  At Risk

  N/A

• Proper control of hazardous materials

  Safe

  At Risk

  N/A

• Record any at risk behaviour

Feedback and suggestions

• Positive Feedback

• Suggestions to make the job safer (employee suggestions)

• Observer's signature

  Sign

• Email completed safety contact to HSEQ Advisor