Information
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Site
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Location
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Observed by
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Conducted on
Behavior-based Safety Checklist
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Safety Observation Steps:
1. Introduce yourself, put the worker at ease, and explain the process. Ask permission to do an observation.
2. Ask the person to explain the job that is being performed and define the hazards and precautions associated with the task/s they are performing.
3. Ask open-ended questions to learn more about at-risk barriers. (Ex: What’s the worst accident that can happen? How could you
be hurt doing this task?) -
[This is an example of how you can use iAuditor to include best practice reference images in your templates to assist with observations]
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4. Observe the job and add comments by tapping NOTE/photos by tapping IMAGE. Provide positive feedback by praising safe behaviors first. Draw out the corrective action that may be required (create this action by tapping ACTION).
5. Obtain a commitment that the individual will carry out this action and thank the person for participating.
CRITICAL SAFE BEHAVIOR
PPE
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Head Protection - (hard hat worn appropriately where the hazard exists)
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Reason
- Training Issue, Unfamiliar
- Management Pressure/System
- Apathy, Insignificant
- Facility or Equipment Condition
- Disagreement on At-Risk Practices
- Personal Factors or Distractions
- Accepted Culture, Peer Pressure
- Environment-related
- Not available
- No response given
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Eye & Face Protection (proper eye and face protection for the task - glasses, face shield, goggles)
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Reason
- Training Issue, Unfamiliar
- Management Pressure/System
- Apathy, Insignificant
- Facility or Equipment Condition
- Disagreement on At-Risk Practices
- Personal Factors or Distractions
- Accepted Culture, Peer Pressure
- Environment-related
- Not available
- No response given
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Hearing Protection (proper hearing protection where the hazard exists - ear plugs, ear muffs)
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Reason
- Training Issue, Unfamiliar
- Management Pressure/System
- Apathy, Insignificant
- Facility or Equipment Condition
- Disagreement on At-Risk Practices
- Personal Factors or Distractions
- Accepted Culture, Peer Pressure
- Environment-related
- Not available
- No response given
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Hand Protection (proper gloves)
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Reason
- Training Issue, Unfamiliar
- Management Pressure/System
- Apathy, Insignificant
- Facility or Equipment Condition
- Disagreement on At-Risk Practices
- Personal Factors or Distractions
- Accepted Culture, Peer Pressure
- Environment-related
- Not available
- No response given
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Body Protection (proper protective clothing, long pants, shirt with at least 4" collar, or FR’s
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Reason
- Training Issue, Unfamiliar
- Management Pressure/System
- Apathy, Insignificant
- Facility or Equipment Condition
- Disagreement on At-Risk Practices
- Personal Factors or Distractions
- Accepted Culture, Peer Pressure
- Environment-related
- Not available
- No response given
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Visibility - Class II (minimum) hi-visibility safety vest
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Reason
- Training Issue, Unfamiliar
- Management Pressure/System
- Apathy, Insignificant
- Facility or Equipment Condition
- Disagreement on At-Risk Practices
- Personal Factors or Distractions
- Accepted Culture, Peer Pressure
- Environment-related
- Not available
- No response given
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Foot Protection (proper foot protection - steel-toed shoes or boots)
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Reason
- Training Issue, Unfamiliar
- Management Pressure/System
- Apathy, Insignificant
- Facility or Equipment Condition
- Disagreement on At-Risk Practices
- Personal Factors or Distractions
- Accepted Culture, Peer Pressure
- Environment-related
- Not available
- No response given
BODY USAGE & POSITION
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The worker is positioning his body to avoid injury by any moving hazards (caught between, falling objects)
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At-Risk Barrier
- Training Issue, Unfamiliar
- Management Pressure/System
- Apathy, Insignificant
- Facility or Equipment Condition
- Disagreement on At-Risk Practices
- Personal Factors or Distractions
- Accepted Culture, Peer Pressure
- Environment-related
- Not available
- No response given
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Lifting (proper lifting techniques - using legs, back straight, weight close to the body, feet flat on the ground, knees bent)
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At-Risk Barrier
- Training Issue, Unfamiliar
- Management Pressure/System
- Apathy, Insignificant
- Facility or Equipment Condition
- Disagreement on At-Risk Practices
- Personal Factors or Distractions
- Accepted Culture, Peer Pressure
- Environment-related
- Not available
- No response given
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Pinch Point (aware of and avoid pinch points - pinch points blocked, maintaining body parts out of pinch points)
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At-Risk Barrier
- Training Issue, Unfamiliar
- Management Pressure/System
- Apathy, Insignificant
- Facility or Equipment Condition
- Disagreement on At-Risk Practices
- Personal Factors or Distractions
- Accepted Culture, Peer Pressure
- Environment-related
- Not available
- No response given
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Awkward Position (proper body mechanics - over-extended, using leg not back when pulling)
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At-Risk Barrier
- Training Issue, Unfamiliar
- Management Pressure/System
- Apathy, Insignificant
- Facility or Equipment Condition
- Disagreement on At-Risk Practices
- Personal Factors or Distractions
- Accepted Culture, Peer Pressure
- Environment-related
- Not available
- No response given
TOOLS & EQUIPMENT
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Position Parked (the vehicle is left in the position which creates the least possibility of an incident and safety of the public)
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At-Risk Barrier
- Training Issue, Unfamiliar
- Management Pressure/System
- Apathy, Insignificant
- Facility or Equipment Condition
- Disagreement on At-Risk Practices
- Personal Factors or Distractions
- Accepted Culture, Peer Pressure
- Environment-related
- Not available
- No response given
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Outrigger pads used
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Reason
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Red danger tape used to block swing path
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Reason
- Training Issue, Unfamiliar
- Management Pressure/System
- Apathy, Insignificant
- Facility or Equipment Condition
- Disagreement on At-Risk Practices
- Personal Factors or Distractions
- Accepted Culture, Peer Pressure
- Environment-related
- Not available
- No response given
EYES ON PATH/HANDS
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Eyes On Path (watching where you're going and go where you're watching - looking for/being aware of hazards).
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At-Risk Barrier
- Training Issue, Unfamiliar
- Management Pressure/System
- Apathy, Insignificant
- Facility or Equipment Condition
- Disagreement on At-Risk Practices
- Personal Factors or Distractions
- Accepted Culture, Peer Pressure
- Environment-related
- Not available
- No response given
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Eyes On Hands (aware of hand placement - watching where hands are placed during work or near hazard, not being distracted)
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At-Risk Barrier
- Training Issue, Unfamiliar
- Management Pressure/System
- Apathy, Insignificant
- Facility or Equipment Condition
- Disagreement on At-Risk Practices
- Personal Factors or Distractions
- Accepted Culture, Peer Pressure
- Environment-related
- Not available
- No response given
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Ascending/Descending (proper climbing techniques on trucks and trailers - facing the ladder, not skipping rungs or steps, hold onto handles)
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At-Risk Barrier
- Training Issue, Unfamiliar
- Management Pressure/System
- Apathy, Insignificant
- Facility or Equipment Condition
- Disagreement on At-Risk Practices
- Personal Factors or Distractions
- Accepted Culture, Peer Pressure
- Environment-related
- Not available
- No response given
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Travel Path (non-hazardous route of travel, a path of the least potential incident - walking/driving around spills, barricades, rough terrain)
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At-Risk Barrier
- Training Issue, Unfamiliar
- Management Pressure/System
- Apathy, Insignificant
- Facility or Equipment Condition
- Disagreement on At-Risk Practices
- Personal Factors or Distractions
- Accepted Culture, Peer Pressure
- Environment-related
- Not available
- No response given
Site Operations
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Is ticket signed by customer?
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Reason
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Are outriggers fully extended
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Reason
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Was a pre-lift safety meeting held
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Reason
- Training Issue, Unfamiliar
- Management Pressure/System
- Apathy, Insignificant
- Facility or Equipment Condition
- Disagreement on At-Risk Practices
- Personal Factors or Distractions
- Accepted Culture, Peer Pressure
- Environment-related
- Not available
- No response given
COMPLETION
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Additional Observations
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Observer Name & Signature