HAZARD IDENTIFICATION & RISK ASSESSMENT (HIRA)

OHS-PR-02-09-F10 PLANNED JOB OBSERVATION REPORT

JOB/TASK: DEPARTMENT:
DATE: TIME:
NAME (Person Observing): NAME (Person Observed):
REASON FOR OBSERVATION
1 NEW WORKER 2 GOOD PERFORMER
3 POOR PERFORMER 4 WORKER WITH KNOWN ABILITY PROBLEM
5 RISK TAKER 6 ROUTINE OBSERVATION
7 ACCIDENT/ INCIDENT (INJURY) 8 INCIDENT (DAMAGE)
EVALUATION
EVALUATION YES/NO/NA COMMENTS
1 SAFE AND LOGICAL STEPS FOLLOWED
2 RISK ASSESSMENT AND JOB SAFE PROCEDURE
CONDUCTED / ATENDED
3 WORK PERMIT AND / OR LOTO APPLIED
4 USED CORRECT TOOLS
5 USED CORRECT P.P.E.
6 WORK PLACE SAFE
7 CONSIDERED OTHE OTHER WORKERS IN THE AREA
8 WORK ORDERLY AND CLEAN UP
9 HAZARDS RECOGNISED AND CORRECTED
COMMENTS AND FINDINDS

RECOMMENDATIONS
RECOMMENDATIONS YES/NO PERSON RESPONSIBLE SIGNATURE DATE
1 WRITE NEW JSP
2 MODIFY EXISTING JSP /PTW
3 MODIFY OR UPDATE RISK ASSESSMENT
4 REPAIR EQUIPMENT
5 REARRANGE EQUIPMENT / WORKPLACE
5 INTRODUCE NEW OR MODIFY OHS RULE
6 RETRAIN WORKER
7 DO ERGONOMIC STUDY
8 OTHER:
REVIEWED WITH EMPLOYEE (AGREEMENT ON ACTION OF RECOMMENDATIONS)

SIGNATURE OBSERVER: SIGNATURE EMPLOYEE:

BASIC (ROOT) CAUSES ANALYSIS

INADEQUATE CAPABILITY INADEQUATE PURCHASING
LACK OF KNOWLEDGE (COMPETANCY) INADEQUATE MAINTENANCE
STRESS – PHYSICAL OR MENTAL INADEQUATE TOOLS AND OTHER EQUIPMENT
IMPROBER MOTIVATION / BEHAVIOUR INADEQUATE WORK STANDARDS
INADEQUATE SUPERVISION/LEADERSHIP ABUSE OR MISUSE
INADEQUATE ENGINERING/EQUIPMENT/SAFETY DEVICES INADEQUATE ERGONOMIC DESIGN
Note: These are deficiencies in your OHS Management System that needs to be corrected.

Page 1 of 1 Rev. 01 [May - 2020] OHSMS Approved

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