AECC/AECI Safe Behavior Observation Report

• Conducted on

  Date

• Prepared by

• Site
  Address

• Specific Location

• Work Description

• Personnel Interviewed

Concerns Expressed by Department Employees

• Concerns Expressed

• Photo of concerns if applicable

  Media

Positive Observations

• Positive Observations

• Photos of positive observations

  Media
Training Effectiveness Evaluation

• Question 1

• Answered Correctly?

  Pass

  Fail

  N/A

• Recommended Items:
  

  
Additional Observations

• 1-Opportunity for Improvement?

  Yes

  No

• Repeat Observation?

  Yes

  No

• Code:

• Observation Description:

• Add media

  Media