BBS Observation

• Date

  Date

• Prepared by

• Area Observed

• Answer all areas observed as Safe, At Risk or N/A. Only mark a question as N/A if you did not observe that topic during your observation.

PIT (Forklift)

• Operator Name

• Seat Belt

  Safe

  At Risk

  N/A

• Note what the at-risk behavior was and action taken

• Forks At Proper Height

  Safe

  At Risk

  N/A

• Note what the at-risk behavior was and action taken

• Body Inside Operator Compartment - Arms, Legs Not Hanging Out Sides

  Safe

  At Risk

  N/A

• Note what the at-risk behavior was and action taken

• Safe Speed

  Safe

  At Risk

  N/A

• Note what the at-risk behavior was and action taken

• Travel Path

  Safe

  At Risk

  N/A

• Note what the at-risk behavior was and action taken

• Sound Horn At Intersections / Blind Spots

  Safe

  At Risk

  N/A

• Note what the at-risk behavior was and action taken

• Eyes On Path Of Travel

  Safe

  At Risk

  N/A

• Note what the at-risk behavior was and action taken

• Proper Lifting / Lowering Of Product

  Safe

  At Risk

  N/A

• Note what the at-risk behavior was and action taken

• Parked Properly (forks lowered, parking break set, ignition off, etc.)

  Safe

  At Risk

  N/A

• Note what the at-risk behavior was and action taken

PPE

• Operator Name

• Eye Protection (Safety Glasses with Side Shields, Safety Shield, Weld Helmet, etc.)

  Safe

  At Risk

  N/A

• Note what the at-risk behavior was and action taken

• Safety Footwear

  Safe

  At Risk

  N/A

• Note what the at-risk behavior was and action taken

• Respirator

  Safe

  At Risk

  N/A

• Note what the at-risk behavior was and action taken

• Gloves

  Safe

  At Risk

  N/A

• Note what the at-risk behavior was and action taken

BODY USE & POSITION

• Operators Name

• Body Out Of Line Of Fire

  Safe

  At Risk

  N/A

• Note what the at-risk behavior was and action taken

• Proper Lifting Technique (Lift With Legs, Not Back; Weight Not Over 50 Pounds)

  Safe

  At Risk

  N/A

• Note what the at-risk behavior was and action taken

• Pinch Point

  Safe

  At Risk

  N/A

• Note what the at-risk behavior was and action taken

• Awkward Position

  Safe

  At Risk

  N/A

• Note what the at-risk behavior was and action taken

MISC

• Operator Name

• Note behavior observed

• Note action taken