HEALTH, SAFETY & ENVIRONMENT

RISK ASSESSMENTS
PLANNED TASK OBSERVATION

DATE : NAME :
DEPARTMENT : OCCUPATION :
JOB OBSERVED :

Time on this job Notification Reason for observation

Yes No Six Monthly observation
Told in advance New worker
_____________ years
Not told To determine if worker has learned to do job safely
and effectively

Is there a written standard procedure for this job ? Yes No

Did you get understanding & acceptance from the worker on doing this work ? Yes No

Could acts / conditions observed lead to Loss potential

Reduced productivity Major
Damage Minor
Injury

1. Are company Health & Safety rules complied with Yes No

2. Is standard procedure for the job followed Yes No
3. Is correct personal protective clothing used Yes No
4. Is person physically fit for the job Yes No
5. Environmental conditions (is there gas, smoke, heat, etc) Yes No
1. Suggested remedies
Remarks 1. Start procedure on this job
2. Revise present procedure
3. Different equipment – tools
4. Engineering revision
5. Retraining
6. Additional – better personal protection
7. Placement of worker
Signature : - Foreman :
- Superintendent :
- Manager / Engineer :

Observation conducted by : Date :

Reviewed with employee : Date :
Employees signature : Co. No. :
Reviewed by : Supt / Eng / Manager : Date :

Note: PTO’S MUST BE DONE FOR HIGH RISK ACTIVITIES, ACCIDENTS,

MONOTONEOUS WORK AND CRITICAL ACTIVITIES. A MINIMUM OF 4 PTO’S
PER WEEK MUST BE CONDUCTED