24/10/2019 Job Safety Observation Form Template | JotForm

Job Safety Observation Form

When making recommendations, consideration should be given to the fundamental

requirements outlined in the relevant Health and Safety Standard and then transferred to the
OFI Register for tracking purposes.
6. Survey the entire area and look for
1. Ask permission to observe
clues about how the task is being done
2. Review Safe Work Service Procedure 7. Discuss at risk behaviours
(SWSP) immediately, if appropriate
3. Ask the person to explain the task they 8. Ask their opinions about possible
are performing and how they prepared for it risks with the task
4. Conduct the observation and record on 9. Complete the form with the person
the JSO form you observed
5. Stay out of the way and don’t create a
10. Give feedback
hazard, wear PPE and minimise distraction

Observer: *

This field is required.

Employee /
Subcontractor: *
This field is required.

Task Observed: *

This field is required.

Site: *

This field is required.

Date: *

24 10 2019 at 3 : 40 PM
Day Month Year Hour Minutes

Health and Safety Standard

Behaviour

Y N N/A

Is there a SWSP for the task?

Has the SWSP been signed by the operator?

Is the SWSP being followed?

Was a SAM being followed?

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Behaviour comments

Personal Protective Equipment

Y N N/A

Is the correct PPE available?

Is the PPE in good condition?

Is the PPE a proper fit and used correctly?

PPE comments

Manual Handling

Y N N/A

Are warm up and stretching excercises undertaken prior to doing physical work?

Are appropriate lifting techniques used?

Is the load too heavy for the individual (greater than 15 kg) or lifting greater than 5 kg above shoulder height?

Is the load awkward or difficult to handle?

Are fingers, hands and other body parts safely positioned to avoid moving objects / machinery?

Manual Handling
comments

Repetitive Tasks

Y N N/A

Is there frequent / prolonged manual handling?

Is there prolonged bending at the waist?

Is there frequent twisting of the back?

Are awkward positions assumed for long periods?

Are hands above the shoulder for long periods?

Repetitive Task
comments

Equipment

Y N N/A

Is the equipment right for the job?

Was equipment visually inspected prior to using?

Is equipment in good condition?

Equipment comments

Housekeeping

Y N N/A

Is the work area clear of trip / slip hazards?

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Are materials / equipment stored correctly?

Are chemicals appropriately labelled and diluted?

Fire fighting equipment accessible / unblocked?

Are hazards barricaded and / or signs erected?

Housekeeping comments

Slips, Trips & Falls

Y N N/A

Are pathways and handrails used?

Is non-slip footwear worn and in good condition?

Are spills cleaned up immediately?

Slips, Trips & Falls

comments

Electricity

Y N N/A

Is the electrical items test status current?

Electricity comments

Food Safety

Y N N/A

Received FoodSafe Handlers training?

Adhering to FoodSafe practices?

Food Safety comments

Vehicle

Y N N/A

Does the driver hold a valid licence (site / general) and has the driver been assessed as competent in line with
Compass procedures?

Has a pre-start inspection been carried out?

Vehicle comments

Communication

Y N N/A

Does the operator communicate effectively with others involved in the task?

Communication
comments

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24/10/2019 Job Safety Observation Form Template | JotForm

Other and Environmental Issues

Y N N/A

Any observations not covered by above?

Other and
Environmental Issues
comments

Corrective Actions

Action / Recommendation Action By Action Date Action Completed

Click to edit

Action / Recommendation Action By Action Date Action Completed

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Action / Recommendation Action By Action Date Action Completed

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Action / Recommendation Action By Action Date Action Completed

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There are errors on the form. Please fix them before continuing.

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