Safety observations are intended to focus on human behaviors. Incidents, near misses, and property damage must be reported to a supervisor immediately and should not be recorded using this observation form.

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* Team Member Name

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* Supervisor - Indicate your supervisor.

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* Date and Time

Date
Time

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* Facility

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* Activity Observed - Indicate type of activity being observed.

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* Additional Description of Activity

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* Activity Area - Indicate specific area/department where observation took place.

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* Number of People Observed

PERSONAL PROTECTIVE EQUIPMENT (PPE)

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(PPE) Select a box only when Unsafe Behavior is observed. If no boxes are selected, the observation will be recorded as safe performance.

TOOLS & EQUIPMENT

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(Tools & Equipment) Select a box only when Unsafe Behavior is observed. If no boxes are selected, the observation will be recorded as safe performance.

ERGONOMICS & EXPOSURE CONTROL

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(Ergonomics & Exposure) Select a box only when Unsafe Behavior is observed. If no boxes are selected, the observation will be recorded as safe performance.

HAND SAFETY

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(Hand) Select a box only when Unsafe Behavior is observed. If no boxes are selected, the observation will be recorded as safe performance.

BACK SAFETY

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(Back) Select a box only when Unsafe Behavior is observed. If no boxes are selected, the observation will be recorded as safe performance.

HOUSEKEEPING

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(Housekeeping) Select a box only when Unsafe Behavior is observed. If no boxes are selected, the observation will be recorded as safe performance.

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* Housekeeping Suggestions

PROCEDURES

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(Procedures) Select a box only when Unsafe Behavior is observed. If no boxes are selected, the observation will be recorded as safe performance.

COMMENTS

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* Comments on the Observation

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* Upload Photo

If an at-risk behavior with the potential to cause injury is observed, the observer must immediately exercise "STOP WORK AUTHORITY" and notify the supervisor so corrective action can be taken.

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