Behavioural safety observation checklist
Visy hse 030-hse form 805
What does this form include?
This form contains 19 sections:
What task / activity is being observed?
PHOTO IF REQUIRED
PERSONAL SAFETY
- Are the workers being observed working in a safe work place?Consider proximity to mobile equipment, exertion and loads lifted, slip and trip hazards, exposures to heat and fumes or proximity to energy sources and task repetition
STANDARD WORKING PROCEDURES
- Are working procedures adhered too?Consider if procedures are not clear, not known , not followed , is a permit to work required, is isolation correct. Is an SOP available and being followed.
SAFE WORK PRACTICE
- Are safe work practices being adhered too?Consider body posture , twisting , turning , straining , pushing or pulling loads. Should loads be lifted by two workers , Locks and danger tags used. Isolations correct . Worker is observant and careful when walking .
HOUSEKEEPING
- Rate the housekeeping in the areaConsider waste , tidiness, Is the workplace orderly . Are tools and equipment stored correctly, Are there hoses around whioch could be a trip hazard
TOOLS & EQUIPMENT
- Are tools and equipment being used, Safe?Consider their condition , right tool for the job and are they used correctly
PPE
- Check Eyes & Face, Ears, Respiratory, Hands, Arms, Feet & Legs, Trunk, etc
PARTICULAR SITE HAZARDS OR CURRENT TOOLBOX TOPICS TO LOOK OUT FOR - LIST BELOW
- Are there any risks present for the listed hazards ?
Safe acts observed
Unsafe acts observed
SAFETY CONVERSATIONS
- IS A SAFETY CONVERSATION REQUIRED?Ask if the worker has carried out a Stop and Think check today?
DISCUSS BETWEEN THE OBSERVERS HOW THE SAFETY CONVERSATION/ DISCUSSION COULD BE IMPROVED?
List corrective action required
List any hazards or near miss incidents to be entered in Vault
Record Actions
- Enter any hazards or near misses into Vault
Observer 1
Observer 2
Use this template