PLANNED TASK OBSERVATION CHECKLIST
Date: Person observed:
Time: Job Title:
Observer Name: Location:
Supervisor: Client:
IDENTIFY POTENTIAL HAZARDS
Chemicals Electric Shock Slips, trips and falls Particals in eyes
Fire Pinch Points Inhalation hazard Moving vehicles
Rotating Equipment Thermal / heat exhaustion Falling hazards Moving machinery
Elevated Work Manual Handling Cave-in Overhead machinery
Spills Inadequate Lighting Excessive Noise Skin exposure
IDENTIFY CONTROLS / CORRECTIONS
Gloves/Overall Safety Shoes Temporary Lighting Chemical resistant overall / gloves
Fire Extinguisher/Hose Hearing Protection Erect barricade Proper body posture
Spill Kit Supplies Eye Protection Seek assistance Respirator
Safety Harness/Fall Protection Hard hat Drink water frequently Dust Mask
Electric Gloves/Flash Suit Leather Gloves Adequate ventilation Safe Working Procedure followed
JOB PREPARATION / REVIEW
RATING INDICATOR: Done 100% safely: 5 points Done, but with some risk / not done: 0 points Not applicable: Not part of calculation
(exclude from calculation i.e. deduct 5 points
from 50 for each exclusion)
Description Done Safely Done with Risk/Not done N/A
1
Document Approved by: CEO
1 Job scope understood?
2 Special requirements / checklist completed?
3 Proper safety equipment available?
4 Proper tools / equipment available and used?
5 Proper PPE available and used?
6 Client requirements taken into consideration?
7 Controls from procedures / risk assessments implemented?
Job Completion Review
8 Waste generated while on site, removed / disposed of correctly?
9 Housekeeping: area cleaned, all equipment stored properly?
10 Job status communicated to affected personnel?
RATING: ____________/ 50
2
Document Approved by: CEO
