SEED - Safety Observation Forms

Section A — Basic Information

Controlling Office

IOCL Location Name

Observer Name

Date

Observed

Individual Group

No. of People Observed

Worker/Contractor Name

Location/Area

Type of Activity

Section B — Observations

PPE (Correct type / Proper use / Condition / Knowledge)

Tools & Tackles (OK / Damaged / Improper use)

Line of Risk (Safe / In danger zone)

Procedures (Following SOP / Deviating)

Housekeeping (Clean & safe / Unsafe & cluttered)

Reaction (Confident / Made corrections / Stopped work / Ran away / Others)

Section C — Awareness Check (Mandatory)

Section D — Human & Cultural Factors

Human Factor

Skill lapse Knowledge mistake Rule mistake Violation

Belief

Done it for long No big risk Nothing will happen to me

Trigger (Event / stimulus that triggered at-risk behaviour)

Section E — Intervention / Action Taken

On-Job Training (knowledge gap / wrong method)

Counseling (attitude / emotional issue / repeated non-compliance)

Coaching (long-term guidance / leadership / culture)

Overall Remark

Signature of Observer (type full name to confirm)

Section A — Basic Information

Controlling Office

IOCL Location Name

Officer Name

Permit No.

Job Location

Number of Workers

Date & Time

Department

Job Description

Permit Type

Section B — Permit Compliance

Permit displayed at site Yes No

Proper authorizations present Yes No

Permit valid / extended with re-assessment Yes No

Job scope, location & equipment clearly stated Yes No

Toolbox talk conducted Yes No

Job Safety Analysis (JSA)

JSA available & job-specific Yes No NA

Control measures in place as per JSA Yes No NA

SIMOPs assessed Yes No NA

Key risks identified & communicated Yes No NA

Workers aware of hazards & responses Yes No NA

Section C — Critical Safety Controls

Energy sources identified & isolated (LOTO) Yes No NA

PPE provided / worn correctly / good condition Yes No NA

Housekeeping adequate Yes No NA

Supervision adequate Yes No NA

Verified de-energization before work Yes No NA

Emergency escape route clear Yes No NA

Section D — Activity-Specific Checks

Hot Work

Not Applicable Fire watch Extinguisher available Gas test < 2hrs Sparks/fire contained

Confined Space

Electrical

Not Applicable Qualified person De-energized & grounded Rated PPE

Excavation

Work at Height

Section E — Behavioral & Cultural Aspects

Workers following safe practices Yes No

Positive safe behaviors noted Yes No

Work performed without unsafe shortcuts Yes No

Awareness Yes No

Observed best practices Yes No

Previous recommendations implemented Yes No

Section F — Observations & Feedback

Safe Behaviors / Positive Observation

At-Risk Behaviors / Area of Improvement

WOPAR Score (auto-calculated)

—

Yes: 0 | No: 0 | Applicable checks: 0

Significant Non-Compliance

Critical Behavior Issue

DSO's Remark

Officer Signature (type full name to confirm)