Behavior Based Safety Observation

• Audit Title

• Document No.

• Inspection Date.

  Date

• Evaluator

• Person being evaluated

• Company of person being evaluated.

Housekeeping

• Aisles/Walkways kept clear?

  Safe

  At Risk

  N/A

• Work area kept organized?

  Safe

  At Risk

  N/A

Personal Protective Equipment

• All appropriate equipment or gear worn correctly?

  Safe

  At Risk

  N/A

• PPE kept in good condition?

  Safe

  At Risk

  N/A

Working Position

• Body position

  Safe

  At Risk

  N/A

• Location in working environment

  Safe

  At Risk

  N/A

• Please describe any improvements that could be made to reduce bodily injuries while performing the job, if any.

Tools and Equipment

• Appropriate tools or equipment being used?

  Safe

  At Risk

  N/A

• Tools or equipment being used correctly?

  Safe

  At Risk

  N/A

• Tools or equipment in good condition?

  Safe

  At Risk

  N/A

Unsafe behaviors

• Were unsafe behaviors observed and action taken to correct and prevent a recurrence?

  Yes

  No

• Describe unsafe behavior and corrective action.

Safety procedures

• Location of safety showers?

  Yes

  No

  N/A

• Location of near-by wind direction indicators?

  Yes

  No

  N/A

• Location of muster stations known?

  Yes

  No

  N/A

• Good Lock-out/Tag-out, Arc Flash, Hot Work Permit, Confined Space Practices?

  Safe

  At Risk

  N/A

• Auditor name and signature

  Sign