Rotek

Engineering

Business Management System

Form No.: RQ-H-47

Rev No.: 3

Safety Observation Checklist

A member of the Eskom Group

NOTE: Utilise one Safety Observation Checklist per activity observed
Date of Safety Observation: 05-05-2016
Area Inspected:
Duration of Observation (Min):

2:00 min

Name of Observer(s):

Date:

26/11/2008

Page:

1 of 2

Canteen yard
Thabiso Mbele

Summary
Group Observed:

Employee

Number of People
Observed:

03

Contractor

Visitor

Number of People Working Safely:

Number of People Working Unsafely:

Safe Actions Observed

01
0

Unsafe Actions Observed

A colleague fixed a loose pavement brick

which could have been a tripping hazard

Activity is:

All Safe

Some Unsafe

(If block is selected there is no need to fill any other information)

(If block is selected please identify the unsafe categories below)

Unsafe Categories
1: Personal Protective Equipment
Head
Eyes and Face
Ears
Respiratory System
Hands and Arms
Trunk
Feet and Legs

4: Tools and Equipment

Wrong for the job
In bad condition
Not used correctly

2: Position of People
Risk of Striking against
Risk of struck by
Caught in or between objects
Falling
Contacting extreme temperatures
Awkward positions
Repetitive motion
Inhaling or Swallowing
Slipping or Tripping
5: Procedures
Procedure not existing / available
Procedure not understood
Procedure not followed
Procedure not adequate / practical

Reasons for Unsafe Behaviour (Mark unsafe reason with the linked category)
Categories
Categories
1 2 3 4 5 6
1 2 3 4 5
Not available
Cost
Unaware of risk
Forgetting
Uncomfortable
Knowledge (training)
Details Of Action Required

Applauded the colleague for this good gesture.

3: Reactions of People
Adjusting PPE
Changing position
Rearranging Job
Stopping Job

6: Housekeeping
Standards not known
Below Standard
No standard in place

Categories
1 2 3 4 5 6

Not practical
Time pressure
Unclear responsibility
Action By
Action By
Date
Who

05-05-2016

Thabiso
Mbele

Action
Closeout
05-05-2016

Electronic Document Validity: Printed Thursday, 23 June 2016. Documents printed via Electronic Media are valid as an authorised edition for 24 hours from time of print, otherwise this
document will be deemed as information only. The document holder is responsible to identify and establish the current revision status from the Technical Information Centre to preclude the
use of invalid and/or obsolete documents. Copyright: This document vest in Rotek Engineering, A member of the Eskom Group and no part thereof may be reproduced without the consent
of the copyright holder.

Rotek
Engineering

Business Management System

Form No.: RQ-H-47

Rev No.: 3

Safety Observation Checklist

A member of the Eskom Group

Date:

26/11/2008

Page:

2 of 2

Energy Efficiency and Environmental Matters

1

Lighting

HVAC

Mark if all safe

Mark if all safe

Are lights switched on in unoccupied area?

Is the air-conditioner temperature set between 21C and 23C?

Are there incandescent lights or CFLs installed (including down lights)?

Are servicing and maintenance contract/procedures in place for HVAC

plant?

Is there design and location of light fitting optimised?

Was the air conditioner filter cleaned in the past 3 months?

Are natural lighting opportunities utilised?

Was the air conditioner serviced in the past year?

Are individual lighting opportunities utilised?

Are air-conditioners switched off at the end of the day, where applicable?

Is there opportunity for more efficient lighting?

How old must the air conditioning units disposed off?

What is the condition of light fittings? Report any damage

How are CFLs and fluorescent tubes disposed of?
3
X

Water-Heating

4
Mark if all safe

Office equipment including computers, Printers and Fax Machines

etc

Mark if all safe

Is the hot water switched off in ablution facilities?

Are PC monitors switched off when not in use?

Is the hot water system, where necessary, adequately insulated and

maintained?

Are computers set on hibernation mode?

Is the temperature set to the most efficient level e.g. 60C for geysers?

Are the screensavers on your monitor disabled?

Is energy efficient flow devices utilised (e.g. aerated showers, restricted

flow etc)?

Are printer/fax machines set to power save mode?

Does the building require a water heating system?

Are Printers/Fax machines switched off at the end of the day?

Are there any leaking taps, toilets, irrigation system?

Are cell phone chargers/docking stations unplugged when not in use?

Are radios on desks switched off when not in use?
How are waste papers, printer and copier cartridges, old computers
disposed of?

Electrical Appliances

Waste

Mark if all safe

Mark if all safe

Are electrical equipment/appliances/water heaters/coolers, microwaves

etc switched off when not in use?

Are steps in place to avoid waste generations?

Are Electrical appliances SABS approved?

What is in place to reduce the amount of waste produced?

Do you know what happened to the waste/does it get separated, re-used,
recycled and where does it get disposed of?
Do you receive confirmation that the waste that needed to be disposed of
was done so by a qualified service provider and legally disposed of?

7
X

Activities that could be Impacting on the Environment

Mark if all safe
Do employees know what environmental impact their activities/function
has?
Are they aware of the procedures they need to follow to control what
they do and thereby protecting the environment?
Are there signs of the environment being impact on i.e. oil spills, litter,
waste not stored properly, burning of waste.
Details of Action Required

Action By Date

Action By Who

Action Close-Out

Electronic Document Validity: Printed Thursday, 23 June 2016. Documents printed via Electronic Media are valid as an authorised edition for 24 hours from time of print, otherwise this
document will be deemed as information only. The document holder is responsible to identify and establish the current revision status from the Technical Information Centre to preclude the
use of invalid and/or obsolete documents. Copyright: This document vest in Rotek Engineering, A member of the Eskom Group and no part thereof may be reproduced without the consent
of the copyright holder.