BBS - Critical Behavior Index

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Office Ergonomics

• Upper back and neck

  Safe

  At Risk

  N/A

• Lower back

  Safe

  At Risk

  N/A

• Shoulders and Elbows

  Safe

  At Risk

  N/A

• Typing / Mousing

  Safe

  At Risk

  N/A

• Recognizing discomfort

  Safe

  At Risk

  N/A

• Breaking up static posture

  Safe

  At Risk

  N/A

PPE

• Eye / Face / Head / Hearing Protection

  Safe

  At Risk

  N/A

• Hand Protection

  Safe

  At Risk

  N/A

• Fall Protection

  Safe

  At Risk

  N/A

• Clothing / Foot Protection

  Safe

  At Risk

  N/A

• Respiratory Protection

  Safe

  At Risk

  N/A

Body Use and Position

• Body Square to Task

  Safe

  At Risk

  N/A

• Break-up / Rotate Repetitive Tasks

  Safe

  At Risk

  N/A

• Focus on Task (hand / eye placement)

  Safe

  At Risk

  N/A

• Pushing / Pulling Objects

  Safe

  At Risk

  N/A

• Breaking Up Static Posture

  Safe

  At Risk

  N/A

• Prolonged Standing (One Foot Forward)

  Safe

  At Risk

  N/A

Lifting

• Knees Bent / Back Straight

  Safe

  At Risk

  N/A

• Objects Close / Weight Test

  Yes

  No

  N/A

• "Build a Bridge"

  Safe

  At Risk

  N/A

Work Environment

• Slip / Trip / Fall Hazard

  Safe

  At Risk

  N/A

• Housekeeping / Material Storage

  Safe

  At Risk

  N/A

• Barricades / Work Area Secured

  Safe

  At Risk

  N/A

• Spill Prevention

  Safe

  At Risk

  N/A

• Chemical / Flammable Hazards addressed

  Safe

  At Risk

  N/A

Tools & Equipment

• Correct Tool Selection

  Safe

  At Risk

  N/A

• Tool Use & Condition

  Safe

  At Risk

  N/A

• Safety Guards in Place

  Safe

  At Risk

  N/A

• Use of Lifting Equipment

  Safe

  At Risk

  N/A

Forklift / Manlift

• Safety Belt / Harness in Place

  Safe

  At Risk

  N/A

• Load Balanced / Stacks / Fork Position

  Safe

  At Risk

  N/A

• Cones and Barricades in Place

  Safe

  At Risk

  N/A

Light Vehicle / Truck

• Visual Pre-inspection Performed: signals, lights, horn

  Safe

  At Risk

  N/A

• Seat Belts / Both Hands on Wheel

  Safe

  At Risk

  N/A

• Looking 15 seconds Ahead

  Safe

  At Risk

  N/A

• Following / Stopping Distances

  Safe

  At Risk

  N/A

• Mirrors / Blind Spots

  Safe

  At Risk

  N/A

• Eyes Moving Frequently / Relevant Objects

  Safe

  At Risk

  N/A

• Space Cushion / Have an "Out"

  Safe

  At Risk

  N/A

• Eye Contact / Proper Use of Signals / Horn

  Safe

  At Risk

  N/A

Reasons for At-Risk Behavior

A1 - disagrees with safe practice

• A1 - Disagrees with safe practice

• Thinks this way is safe

• Disagrees with the observer on safe practice for the job

• A2 - Personal Choice / Shortcuts

• Aware of hazard but too rushed / extra work

• Chooses to work at risk for medical reasons

• Chooses to not spend money for PPE

• Peers all do the job this wayA3

• A3 - Job Knowledge

• Unaware of safe practices for specific job

• Unaware of risks associated with work location

• Doesn't think a specific safe practice applies to the job

• A4 - Job Focus

• Lost focus, thinking about anything other than current task

• A5 - Facilities / Equipment

• Different Design of facilities or equipment needed

• Proper tools or safety equipment not available

• A6 - Management System

• Leader supports doing the job this way

• Leader disagrees with safe practice

• Name and signature of observer

  Sign

• Date and time of completion

  Date