Title Page
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Site conducted
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Conducted on
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Prepared by
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Location
Untitled Page
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Initial reaction to the observation
- PPE adjustment
- Change of positions
- Readjusting work
- Stopping work
- Doing LOTO
- Adjusting safety accesories
- All good
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PPE properly used
- Head
- Ears
- Eyes and face
- Respiratory protection
- Body
- Arms
- Hands
- Legs and feet
- All good
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Evaluate equipment and tools
- No suitable for the work
- Use incorrectly
- In unsafe condition
- Stored inappropriate when not in use
- All good
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Evaluate body’s condition
- 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
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Is the work standard?
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Work area conditions
- Slips or trips
- Equipment guards are not in place
- Blocked evacuation hallways or doors
- Emergency equipment blocked
- Other
- All good
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Description of the observation
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Safety act. How to reinforce worker performance?
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Insecure act. What immediate action was taken to avoid an injury?
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Workers comments
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Insecure condition. What agreements were made to resolve the situation?
