Title Page
-
Department/Location
- BHV
- DHV
- Blending
- Processing
- Logistics
- Maintenance
-
Conducted on
-
Prepared by
-
Shift
-
Participant Names
-
Time Spent
Observations
-
Did you engage with the employee(s) around a safety topic?
-
Why not?
-
What was the topic?
-
Did the employee(s) have a safety call out or idea?
-
What was it?
-
Did the employee(s) display any unsafe or at-risk behavior outside of the established job function or task
-
Describe what they were and how you provided feedback?
Job/Task Related Behavior
-
Are employees adjusting their PPE? (Example: putting on safety glasses or gloves)
-
What were the behaviors?
-
Are employees adjusting their body position? (Example: lifting incorrectly to lifting correctly)
-
What were the behaviors?
-
Is the area free from hazards?
-
I observed employee(s) working Safe/Unsafe:
-
What was the safe behavior?
-
What was the behavior and what did you and the team member do about it?
-
How did you or the employee(s) correct the hazard:
-
Did the employee(s) know how to access job aids, JIBs, or have their binder available?
