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Lumiform / Templates / Telecommunications Best Practices: Task Observation Form Template

Telecommunications Best Practices: Task Observation Form Template

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Telecommunications Best Practices: Task Observation Form Template

TELECOMMUNICATIONS SAFETY ESSENTIALS

OBSERVATION (MRO) Minimal Risk Behaviour (ARB) At Risk Behaviour (ARS) At Risk Situation

1. Electrical Work
2. Working at Heights
3. Driver Alertness
4. Working in the Vicinity of Utility Services
5. Excavation Works
6. Working in the Vicinity of Vehicular Traffic
7. Working in and Around Mobile Plant
8. Working in Remote or Isolated Locations
9. Heavy Lifting
10. Exposure to Asbestos

Observations

Work Methods / SHEWMS (WM)
SHEWMS / Risk Assessment is available and specific to activity?
Mark this a corrective action ?
Actioned By Who?
Action By Date
SHEWMS / Risk Assessment highlights applicable hazard (Particularly Safety Essentials)?
Mark this a corrective action ?
Actioned By Who?
Action By Date
SHEWMS / Risk Assessment is signed and understood by workers?
Mark this a corrective action ?
Actioned By Who?
Action By Date
SHEWMS / Risk Assessment is effective at reducing risk
Mark this a corrective action ?
Actioned By Who?
Action By Date
SHEWMS / Risk Assessment complies with Safety Essential Requirements
Mark this a corrective action ?
Actioned By Who?
Action By Date
SHEWMS / Risk Assessment are adhered to?
Mark this a corrective action ?
Actioned By Who?
Action By Date
Isolations, Tags, Permits?
Mark this a corrective action ?
Actioned By Who?
Action By Date
Tools appropriate for job, maintained and used correctly?
Mark this a corrective action ?
Actioned By Who?
Action By Date
Personal Protective Equipment (PPE)

Choose Observation Category:

Eyes and Face
Mark this a corrective action ?
Actioned By Who?
Action By Date
Ears
Mark this a corrective action ?
Actioned By Who?
Action By Date
Feet and Legs
Mark this a corrective action ?
Actioned By Who?
Action By Date
Respiratory
Mark this a corrective action ?
Actioned By Who?
Action By Date
Hands and Arms
Mark this a corrective action ?
Actioned By Who?
Action By Date
Housekeeping (HK)

Choose Observation Category:

Work area clear of slip and trip hazards?
Mark this a corrective action ?
Actioned By Who?
Action By Date
Storage of equipment and materials adequate?
Mark this a corrective action ?
Actioned By Who?
Action By Date
Registers up to date?
Mark this a corrective action ?
Actioned By Who?
Action By Date
Field Workforce Information Pack available and up to date?
Mark this a corrective action ?
Actioned By Who?
Action By Date
Body Position (BP)

Choose Observation Category:

Posture?
Mark this a corrective action ?
Actioned By Who?
Action By Date
Repetitive Movements?
Mark this a corrective action ?
Actioned By Who?
Action By Date
Lifting of Objects?
Mark this a corrective action ?
Actioned By Who?
Action By Date
Footing?
Mark this a corrective action ?
Actioned By Who?
Action By Date
Inhaling?
Mark this a corrective action ?
Actioned By Who?
Action By Date
Falling?
Mark this a corrective action ?
Actioned By Who?
Action By Date
Job Focus (JF)

Choose Observation Category:

Eyes on Task?
Mark this a corrective action ?
Actioned By Who?
Action By Date
Distractions?
Mark this a corrective action ?
Actioned By Who?
Action By Date
Rushing?
Mark this a corrective action ?
Actioned By Who?
Action By Date
Short Cuts?
Mark this a corrective action ?
Actioned By Who?
Action By Date
Improvisation?
Mark this a corrective action ?
Actioned By Who?
Action By Date
Verbal Interaction?
Mark this a corrective action ?
Actioned By Who?
Action By Date
Awareness of others?
Mark this a corrective action ?
Actioned By Who?
Action By Date

Observers Signature

Please sign your name
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Please note that this checklist template is a hypothetical appuses-hero example and provides only standard information. The template does not aim to replace, among other things, workplace, health and safety advice, medical advice, diagnosis or treatment, or any other applicable law. You should seek your professional advice to determine whether the use of such a checklist is appropriate in your workplace or jurisdiction.