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NOSA 4.4.6.30.

WI 2

Written Safe Work Procedure – Job Observation


JOB TITLE: LOCATION: SAFE WORK PROCEDURE NO. 07

TASK: SECURITY PROCESS – RANDOM CHECK OBSERVATION DONE BY:

PLANNED JOB
OBSERVATION
TASKS CRITICAL STEPS SAFETY STEPS SAFE PRACTICES (Step carried out
Sequential Job Steps Potential injury and illness PPE, standards actions and procedures correct: (Yes /
No)
Checking of truck Is the vehicle stationery Is the driver wearing reflector and Social distance kept between
safety shoes? employee and driver
(Gate register completed).
Applying chocks Is the truck stationery and engine Does the driver disembark and Does security do the 360
switched off? apply chocks? degree check for other
vehicles?
Checking of stock Is the stock off the truck and no loose Is the stock wrap safely removed No moving vehicles in the
hangings? from around the pallets and area where random is
rewrapped. conducted.

NAME OF EMPLOYEE BEING OBSERVED: SIGNATURE: DATE:

Good Worker Poor Performer Accident Repeater New Worker


Risk Taker High Risk Job New / Unusual Job Ergonomically Factor
Two Year Period

Deviations Noted / Recommendations:

Transfer Worker Induction Training Re-Induction Training on Work Procedure


Safety Training Provider Protection Discipline On the Job Training

Re-evaluation Completed
NAME OF EMPLOYEE COMPLETING PLANNED JOB OBSERVATION SUCCESSFUL – DATE OBSERVATION WAS RE-DONE:
SECOND OBSERVATION: (CIRCLE)
YES / NO

COMMENTS:
NOSA 4.4.6.30.WI 2

Written Safe Work Procedure – Job Observation


JOB TITLE: LOCATION: SAFE WORK PROCEDURE NO. 07

TASK: SECURITY PROCESS – RANDOM CHECK OBSERVATION DONE BY:

PLANNED JOB
OBSERVATION
TASKS CRITICAL STEPS SAFETY STEPS SAFE PRACTICES (Step carried out
Sequential Job Steps Potential injury and illness PPE, standards actions and procedures correct: (Yes /
No)
Checking of truck Is the vehicle stationery Is the driver wearing reflector and Social distance kept between
safety shoes? employee and driver
(Gate register completed).
Applying chocks Is the truck stationery and engine Does the driver disembark and Does security do the 360
switched off? apply chocks? degree check for other
vehicles?
Checking of stock Is the stock off the truck and no loose Is the stock wrap safely removed No moving vehicles in the
hangings? from around the pallets and area where random is
rewrapped. conducted.

NAME OF EMPLOYEE BEING OBSERVED: SIGNATURE: DATE:

Good Worker Poor Performer Accident Repeater New Worker


Risk Taker High Risk Job New / Unusual Job Ergonomically Factor
Two Year Period

Deviations Noted / Recommendations:

Transfer Worker Induction Training Re-Induction Training on Work Procedure


Safety Training Provider Protection Discipline On the Job Training

Re-evaluation Completed
NAME OF EMPLOYEE COMPLETING PLANNED JOB OBSERVATION SUCCESSFUL – DATE OBSERVATION WAS RE-DONE:
SECOND OBSERVATION: (CIRCLE)
YES / NO

COMMENTS:

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