Site conducted
Conducted on
Date
Prepared by
Location
Address
Initial reaction to the observation
Select
PPE adjustment
Change of positions
Readjusting work
Stopping work
Doing LOTO
Adjusting safety accesories
All good
PPE adjustment Change of positions Readjusting work Stopping work Doing LOTO Adjusting safety accesories All good
PPE properly used
Select
Head
Ears
Eyes and face
Respiratory protection
Body
Arms
Hands
Legs and feet
All good
Head Ears Eyes and face Respiratory protection Body Arms Hands Legs and feet All good
Evaluate equipment and tools
Select
No suitable for the work
Use incorrectly
In unsafe condition
Stored inappropriate when not in use
All good
No suitable for the work Use incorrectly In unsafe condition Stored inappropriate when not in use All good
Evaluate body’s condition
Select
Hit against objects
Fire line - hit by fall
Contact with extreme temperatures
Inhale / contact with chemicals
Over extension
Repetitive movement
Contact with electric energy
Strange position
Static position
All good
Hit against objects Fire line - hit by fall Contact with extreme temperatures Inhale / contact with chemicals Over extension Repetitive movement Contact with electric energy Strange position Static position All good
Is the work standard?
Not available
It’s not understood
It is not appropriate
Not followed
All good
Work area conditions
Select
Slips or trips
Equipment guards are not in place
Blocked evacuation hallways or doors
Emergency equipment blocked
Other
All good
Slips or trips Equipment guards are not in place Blocked evacuation hallways or doors Emergency equipment blocked Other All good
Description of the observation
Safety act. How to reinforce worker performance?
Insecure act. What immediate action was taken to avoid an injury?
Workers comments
Insecure condition. What agreements were made to resolve the situation?
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Gilberto Bacamuniz
BBS English
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