A behavior-based safety observation checklist is used by safety managers to identify safe and at-risk behavior of frontline workers. Use this checklist to assess employees’ ergonomics, PPE, tools and equipment, work areas, and procedures.
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Information
Site
Location
Department observed
Safety Manager
Conducted on
Behavior-based Safety Observation Checklist
Ergonomics
Safe
Body mechanics
Body posture & position
Adequate force used
Pushing, pulling, reaching
Lifting & lowering techniques
Eyes on path & work
Body and/or hands in right position
None
At Risk
Body mechanics
Body posture & position
Adequate force used
Pushing, pulling, reaching
Lifting & lowering techniques
Eyes on path & work
Body and/or hands in right position
None
Personal Protective Equipment
Safe
Hand protection
Fall protection
Eye & face
Respirator, dust mask
Hearing protection
Usage
Condition
None
At Risk
Hand protection
Fall protection
Eye & face
Respirator, dust mask
Hearing protection
Usage
Condition
None
Tools & Equipment
Safe
Selection
Usage
Condition
Mobile equipment
Guards, barriers & warnings
Motorized equipment
None
At Risk
Selection
Usage
Condition
Mobileequipment
Guards, barriers & warnings
Motorized equipment
None
Environment & Work Areas
Safe
Housekeeping
Walking surfaces
Working surfaces
Walkways, fire equipment & emergency access routes
Contact with temperature
Contact with rotating equipment
Contact with sharp edges
Pinch point
Walking under suspended loads
Confined space
Driver safety
Electrical safety
Harmful substances
Hazardous materials
None
At Risk
Housekeeping
Walking surfaces
Working surfaces
Walkways, fire equipment & emergency access routes
Contact with temperature
Contact with rotating equipment
Contact with sharp edges
Pinch point
Walking under suspended loads
Confined space
Driver safety
Electrical safety
Harmful substances
Hazardous materials
None
Procedures
Safe
Fall protection
Chemical use
LOTO
Adherence
Awareness
Availability
Other
Specify
Hand protection
Fall protection
Eye & face
Respirator, dust mask
Hearing protection
Usage
Condition
None
At Risk
Fall protection
Chemical use
LOTO
Adherence
Awareness
Availability
Other
Specify
Hand protection
Fall protection
Eye & face
Respirator, dust mask
Hearing protection
Usage
Condition
None
Sign Off
Additional Observations
Safety Manager Name & Signature
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Behavior-based Safety Observation Checklist
A behavior-based safety observation checklist is used by safety managers to identify safe and at-risk behavior of frontline workers. Use this checklist to assess employees’ ergonomics, PPE, tools and equipment, work areas, and procedures.
The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions.
The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice.
You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction.
You should independently determine whether the template is suitable for your circumstances.
