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Form 5.4a - Job Observation Control Sheet

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valveworkshse
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77 views1 page

Form 5.4a - Job Observation Control Sheet

Uploaded by

valveworkshse
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLS, PDF, TXT or read online on Scribd
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AMIBASE (PTY) LTD

Job Observation Control Sheet - Form 5.4a Rev 01


JOB: DEPARTMENT:

DATE: TIME:

NAME (Who Observing) NAME (Who Observed)

NOTIFICATION

Told in Advance Yes No

REASON FOR OBSERVATION


Observation YES/NO Observation YES/NO
1 NEW WORKER 2 GOOD PERFORMER

3 POOR PERFORMER 4 WORKER WITH KNOWN ABILITY PROBLEM

5 RISK TAKER 6 ROUTINE OBSERVATION

7 INCIDENT (INJURY) 8 INCIDENT (DAMAGE)

EVALUATION
EVALUATION YES/NO COMMENTS
1 Safe and logical steps followed

2 Used correct tools

3 Used correct PPE

4 Work place safe

5 Health and safety of other workers considered

6 Work orderly and clean up

7 Dangers recognised

COULD ACTS / CONDITIONS OBSERVED LEAD TO LOSS POTENTIAL

1 Reduced Productivity Yes No Minor Yes No

2 Damages Yes No Major Yes No

3 Injuries Yes No

RECOMMENDATIONS

RECOMMENDATIONS PERSON RESPONSIBLE SIGNATURE DATE

EVALUATION YES/NO

1 Start procedure on this Job 1 Engineering Revision

2 Revise present Safe Work Instruction 2 Re-Training


3 Different equipment tools 3 Placement of Worker
4 Additional - better personal protection 4

REVIEWED WITH EMPLOYEE

SIGNATURE OBSERVER: SIGNATURE EMPLOYEE:

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