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

Observer:*
Employee / Subcontractor:*
Task Observed:*
Site:*
Date:*
DayMonthYearHourMinutesAM/PM Option
Health and Safety Standard
Behaviour
Y N N/A
Is there a SWSP for the task? 1 2 3
Has the SWSP been signed by the operator? 4 5 6
Is the SWSP being followed? 7 8 9
Was a SAM being followed? 10 11 12
Behaviour comments
Personal Protective Equipment
Y N N/A
Is the correct PPE available? 13 14 15
Is the PPE in good condition? 16 17 18
Is the PPE a proper fit and used correctly? 19 20 21
PPE comments

	Y	N	N/A
Is there a SWSP for the task?	1	2	3
Has the SWSP been signed by the operator?	4	5	6
Is the SWSP being followed?	7	8	9
Was a SAM being followed?	10	11	12

	Y	N	N/A
Is the correct PPE available?	13	14	15
Is the PPE in good condition?	16	17	18
Is the PPE a proper fit and used correctly?	19	20	21

Manual Handling

	Y	N	N/A
Are warm up and stretching excercises undertaken prior to doing physical work?	22	23	24
Are appropriate lifting techniques used?	25	26	27
Is the load too heavy for the individual (greater than 15 kg) or lifting greater than 5 kg above shoulder height?	28	29	30
Is the load awkward or difficult to handle?	31	32	33
Are fingers, hands and other body parts safely positioned to avoid moving objects / machinery?	34	35	36

Repetitive Tasks

	Y	N	N/A
Is there frequent / prolonged manual handling?	37	38	39
Is there prolonged bending at the waist?	40	41	42
Is there frequent twisting of the back?	43	44	45
Are awkward positions assumed for long periods?	46	47	48
Are hands above the shoulder for long periods?	49	50	51

Repetitive Task comments
Equipment
Y N N/A
Is the equipment right for the job? 52 53 54
Was equipment visually inspected prior to using? 55 56 57
Is equipment in good condition? 58 59 60
Equipment comments

	Y	N	N/A
Is the equipment right for the job?	52	53	54
Was equipment visually inspected prior to using?	55	56	57
Is equipment in good condition?	58	59	60

Housekeeping

	Y	N	N/A
Is the work area clear of trip / slip hazards?	61	62	63
Are materials / equipment stored correctly?	64	65	66
Are chemicals appropriately labelled and diluted?	67	68	69
Fire fighting equipment accessible / unblocked?	70	71	72
Are hazards barricaded and / or signs erected?	73	74	75

Housekeeping comments
Slips, Trips & Falls
Y N N/A
Are pathways and handrails used? 76 77 78
Is non-slip footwear worn and in good condition? 79 80 81
Are spills cleaned up immediately? 82 83 84
Slips, Trips & Falls comments
Electricity
Y N N/A
Is the electrical items test status current? 85 86 87
Electricity comments
Food Safety
Y N N/A
Received FoodSafe Handlers training? 88 89 90
Adhering to FoodSafe practices? 91 92 93
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? 94 95 96
Has a pre-start inspection been carried out? 97 98 99
Vehicle comments
Communication
Y N N/A
Does the operator communicate effectively with others involved in the task? 100 101 102
Communication comments
Other and Environmental Issues
Y N N/A
Any observations not covered by above? 103 104 105
Other and Environmental Issues comments
Corrective Actions
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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Action / Recommendation Action By Action Date Action Completed
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Should be Empty:

	Y	N	N/A
Are pathways and handrails used?	76	77	78
Is non-slip footwear worn and in good condition?	79	80	81
Are spills cleaned up immediately?	82	83	84

	Y	N	N/A
Received FoodSafe Handlers training?	88	89	90
Adhering to FoodSafe practices?	91	92	93

	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?	94	95	96
Has a pre-start inspection been carried out?	97	98	99

Health and Safety Standard