Behavior Observation (Pink Card)

• Behavior Observation

• Site

• Conducted on

  Date

• Prepared by

• Location
  Address

PPE

• Eye Protection

  Safe

  At Risk

  N/A

• Head Protection

  Safe

  At Risk

  N/A

• Hand Protection

  Safe

  At Risk

  N/A

• Hearing Protection

  Safe

  At Risk

  N/A

• Breathing Protection

  Safe

  At Risk

  N/A

• Foot Protection

  Safe

  At Risk

  N/A

• Body Protection

  Safe

  At Risk

  N/A

Body Positioning

• Line of Fire

  Safe

  At Risk

  N/A

• Pinch Points

  Safe

  At Risk

  N/A

• Lifting Technique

  Safe

  At Risk

  N/A

• Extending

  Safe

  At Risk

  N/A

• Ergonomics

  Safe

  At Risk

  N/A

Visual Focusing / Attention to Surroundings

• Focusing on Task

  Safe

  At Risk

  N/A

• Awareness of Surroundings

  Safe

  At Risk

  N/A

• Guarding for Potential Hazards

  Safe

  At Risk

  N/A

Pacing of Work

• Speed of Working

  Safe

  At Risk

  N/A

• Temperature Considerations

  Safe

  At Risk

  N/A

Work Practices

• Communication

  Safe

  At Risk

  N/A

• Use of Tools and Equipment

  Safe

  At Risk

  N/A

• Appropriate Permits

  Safe

  At Risk

  N/A

• Housekeeping

  Safe

  At Risk

  N/A

Comments from Observer

• Safe Behaviors

• At Risk Behaviors

• Comments from Observee