BBS

• Near Miss

  Yes

  No

  N/A

• # at risk?

• # safe?

• BBS observation

  Yes

  No

  N/A

• # safe?

• # at risk?

• Date & time

  Date

• Name of Observer

• Joint Observation?

• 2nd observer name.

• Home terminal?

• Customer name? (e.g. Oxy)

• Customer location? (e.g. rig #) I

• Description of job being performed?

• Description of observation?

• Description of feedback immediately provided?

• Supervisor feedback?

Analysis of At Risk Behaviors observed.

Check all that apply

• Type of observation

  General Inspection

  Observation

  Task Assessment

Answer yes or no to the subgroup which the BBS pertains, and select if at risk or safe.

• Job Planning

  Select Yes No N/A

  • Yes
  • No
  • N/A

• 101 Safe Work Permit, tailgate, JSA complete

  Safe

  At Risk

  N/A

• 102 Short Service Employees identified and informed

  Safe

  At Risk

  N/A

• 103 Avoiding obstacles

  Safe

  At Risk

  N/A

• 104 Spotter use hand signals

  Safe

  At Risk

  N/A

• 105 Obeying posted signs/limits/warnings

  Safe

  At Risk

  N/A

• Vehicle Operation

  Select Yes No N/A

  • Yes
  • No
  • N/A

• 201 Basic Safety(lights, seatbelt, signals)

  Safe

  At Risk

  N/A

• 202 Speed appropriate to situation

  Safe

  At Risk

  N/A

• 203 Use of spotters

  Safe

  At Risk

  N/A

• 204 Securing load

  Safe

  At Risk

  N/A

• 205 Stabilizing trailer yo remain

  Safe

  At Risk

  N/A

• Forklift Operation

  Select Yes No N/A

  • Yes
  • No
  • N/A

• 301 Speed of approach

  Safe

  At Risk

  N/A

• 302 Angle of approach

  Safe

  At Risk

  N/A

• 303 Speeding of lifting load/lowering load

  Safe

  At Risk

  N/A

• Body Mechanics

  Select Yes No N/A

  • Yes
  • No
  • N/A

• 401 Lifting/ pulling/ pushing/ carrying

  Safe

  At Risk

  N/A

• 402 Line of fire

  Safe

  At Risk

  N/A

• 403 Eyes on work/ path

  Safe

  At Risk

  N/A

• 404 Pinch points/ hand placement

  Safe

  At Risk

  N/A

• 405 Pinch points/ body

  Safe

  At Risk

  N/A

• 406 Repetitive motion

  Safe

  At Risk

  N/A

• 407 Climbing

  Safe

  At Risk

  N/A

• 408 Work surface stable and clean

  Safe

  At Risk

  N/A

• 409 Positioned to avoid twisting

  Safe

  At Risk

  N/A

• 410 Avoiding being sprayed, hit, struck

  Safe

  At Risk

  N/A

• PPE

  Select Yes No N/A

  • Yes
  • No
  • N/A

• 501 PPE: Hard hat, H2S monitor, eye protection, steel-toed boots, FRC’s, Gloves

  Safe

  At Risk

  N/A

• Tools

  Select Yes No N/A

  • Yes
  • No
  • N/A

• 601 Proper tool available & in use

  Safe

  At Risk

  N/A

• 602 Tool used properly for job

  Safe

  At Risk

  N/A

• 603 Wheel Chocks used

  Safe

  At Risk

  N/A

• Conditions not under MWT control

  Select Yes No N/A

  • Yes
  • No
  • N/A

• 701 Guatds or Protective Devices

  Safe

  At Risk

  N/A

• 702 Material/ Tool Storage

  Safe

  At Risk

  N/A

• 703 Access to fire/ safety equipment

  Safe

  At Risk

  N/A

• 704 Houskeeping

  Safe

  At Risk

  N/A

• 705 Waste properly disposed

  Safe

  At Risk

  N/A

• 706 Work environment (noise, heat, etc.)

  Safe

  At Risk

  N/A

• 707 Tight work space/ crowded

  Safe

  At Risk

  N/A

• 708 Emissions/ Discharge

  Safe

  At Risk

  N/A

• 709 Spill control equipment

  Safe

  At Risk

  N/A

CBI CODE

• CBI CODE

Root Cause

• Root Cause