Behavioral Based Observations

• Behavioral Based Observations

• Prepared by

• Select date

  Date
• Location
  Address

Job Task Observed

Description of Specific Task Observed

Positive Comments

Conclusions

Personal Protective Equipment

• Hearing protection

  Yes

  No

  N/A

• Head Protection/Hard Hats

  Yes

  No

  N/A

• Eye/Face Protection/Goggles/Face Shield

  Yes

  No

  N/A

• Hand Protection

  Yes

  No

  N/A

• Foot Protection/Work Boots above ankles

  Yes

  No

  N/A

• Respiratory Protection

  Yes

  No

  N/A

• Fall Protection

  Yes

  No

  N/A

• Protective Clothing<br>(e.g. safety vest & hi-vis)

  Yes

  No

  N/A

Body Use and Positioning

• Correct when Lifting, Pushing, Pulling, Reaching or Bending

  Yes

  No

  N/A

• Around Pinch/Scrape Point-Sharp Objects and Moving Equipment (line-of-fire?)

  Yes

  No

  N/A

• When Mounting/Dismounting (e.g. uses 3-point stance) Ladder & Scissor Lifts

  Yes

  No

  N/A

• Materials Being Moved Correctly/Proper Lifting

  Yes

  No

  N/A

Work Environment

• Work/Walk Surface Free of Trip/Fall Obstructions and Slip Hazards

  Yes

  No

  N/A

• Housekeeping/ Storage/ Means of Egress Clear (e.g. of tools and equipment)

  Yes

  No

  N/A

• Work Area Defined and Secured ( e.g. warning devices, barricades, cones, flags, Electrical Danger Signs )

  Yes

  No

  N/A

• Assured Grounding/GFCI's (e.g. available, identified, tested weekly?)

  Yes

  No

  N/A

• Temporary Lighting on Dedicated Circuit/ Properly Secured

  Yes

  No

  N/A

• Adequate Lighting - 5fc in General Areas

  Yes

  No

  N/A

Operating Procedures

• JHA / Job Plan / Pre-Task

  Yes

  No

  N/A

• Work Permit/ Authorization to work (e.g. Hot Work, LOTO, Confined Space Entry, Excavations )

  Yes

  No

  N/A

• JHA / Procedures Followed

  Yes

  No

  N/A

• Check Area for Hazards

  Yes

  No

  N/A

• Interfaces with Other Functions ( awareness of other activities/personnel on site )

  Yes

  No

  N/A

• Forklift Operations Certified

  Yes

  No

  N/A

Tools / Equipment

• Hand Tool Selection, Condition & Use

  Yes

  No

  N/A

• Power Tool Selection, Condition & Use

  Yes

  No

  N/A

• Ladder Selection, Condition & Use

  Yes

  No

  N/A

• Powder Acuated Selection, Condition & Use

  Yes

  No

  N/A