Title Page
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Month:
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Reviewed By:
OBS Data Review
- Week Number:
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Week Ending:
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Were any OBS Checklists completed this week?
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Number of OBS completed:
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For each section, indicate whether the behavior was safe, at risk, or not applicable.
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Personal Protective Equipment
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Select which action(s) was at-risk:
- Eye Protection
- Hand Protection
- Head Protection
- Foot Protection
- Respiratory Protection
- Face Shield / Full Face
- Hearing Protection
- Fall Protection
- Nomex / FRC
- Other
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Personal Protective Defenses
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Select which action(s) was at-risk:
- Barricades / Barriers
- Tags
- Means of Energizing
- Lock-Out
- Tape / Rope
- Signage
- Blanking
- Other
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Positions and Actions of People
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Select which action(s) was at-risk:
- Inattention / Rushing
- Slippery Surfaces
- Exposure to Elements
- Eyes / Mind Not on Task
- Poor Access
- Improper Positions
- Poor Communication
- Other
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Tools and Equipment
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Select which action(s) was at-risk:
- Not in Working Order
- Inadequate
- Not Available
- Wrong Tool/Equipment
- Unsafe Handling
- Positioning
- Other
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Housekeeping
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Select which action(s) was at-risk:
- Clean-up During Job
- Time Constraints
- Tripping
- Weather
- Other
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Procedures
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Select which action(s) was at-risk:
- Training / Understanding
- Oversight
- Time Contraints
- Other
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Near Miss Reporting Program
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Select which action(s) was at-risk:
- Training / Understanding
- Oversight
- Time Contraints
- Other
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TASC Cards
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Select which action(s) was at-risk:
- No Training
- Not Filled Out
- Hazard Not Eliminated / Controlled
- No TASC Card
- No Comments
- Other
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Signature
