Document: PTO –

Pouring Of Concrete
PLANED TASK OBSERVATION Rev 2
Next Revision date:
Pouring of Concrete 29/7/16
Date Issued 20/7/15

Date Department
Work Area Section
Employee Being Observed
How often is Task performed Company Name
Machine/Equipment No being used Observers Name
Task being observed ID Number/ Coy No
Reason for observation Change Management Legal Compliance
New Worker Unplanned Task
New Task Ergonomic Factor
Known Risk Taker Incident Repeater
Poor Performer Good Performer
New/Unfamiliar Equipment Complicated Task

1. Task Steps being observed

Was an continues risk assessment conducted by all team members?

Pre use check carried out by whom? Name

Is there good communication between the chute operator and his team members?

Was the Concrete Truck Operator Inducted on the DSTI and Signed as acknowledgement?

Is the Concrete Truck well positioned?

Are Stop Blocks utilized?

Does the Concrete Truck operator remain in the Truck whist his assistant open and Close the Chute?

Can the employee hurt someone else while performing the task?

Can any member of the team slip, trip or fall over anything whilst performing the task?

Is the work space clear of any tools or materials lying around?

What PPE is the employee wearing whilst performing the task?

Is this the correct PPE?

Does the employee close the chute before the truck leaves?

Is the employee trained on Concrete MSDS and is the MSDS available?

5. Suggested Improvements (TO BE COMPLETED BY THE SUPERVISOR )

Revise SOP? Yes Use different PPE? Yes Yes Yes Yes

Page 1 of 2 Printed: 22 October 2022

 Document: PTO –
Pouring Of Concrete
PLANED TASK OBSERVATION Rev 2
Next Revision date:
Pouring of Concrete 29/7/16
Date Issued 20/7/15

No No Engineering change No Re-Train No Placement of No

required? employee? employee?

Employee Task Observation

Employee Name: ______________________________________ I.D. No.: ______________

Job Title: _________

Date Assigned to Job: __

Operating Procedures Checked

Number Title Date Reviewed

SOP
RA

6. Feedback by observer to employee

1. TASK STEPS
DEVIATION CORRECTION/COACHING EMPLOYEE SIGNATURE

2. PPE
DEVIATION CORRECTION/COACHING EMPLOYEE SIGNATURE

3. EQUIPMENT CONDITION
DIVIATION CORRECTION/COACHING EMPLOYEE SIGNATURE

7. Acknowledgement and agreement on feedback received

Observation conducted by: Signature Date
Reviewed with Employee: Signature Date
Reviewed by Site Manager: Signature Date

Page 2 of 2 Printed: 22 October 2022