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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24/10/2019 Job Safety Observation Form Template | JotForm
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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24/10/2019 Job Safety Observation Form Template | JotForm
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
Click to edit
Action / Recommendation Action By Action Date Action Completed
Click to edit
Action / Recommendation Action By Action Date Action Completed
Click to edit
There are errors on the form. Please fix them before continuing.
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