Anonymous

Behavioral Safety Observation

Behavior observation to ensure correct isolation of equipment prior to performing a task inside machine guarding.

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Use this Template

Title Page

Name of Observer
Name of employee observed
Line
Date
Start Time

Observation

Written procedure reviewed prior to starting LOTO?
Equipment was stopped by its normal stopping procedure?
All energy sources locked out using the procedure?
The machine was cycled or tested to ensure stored energy was no longer present before going past guarding?
Feedback type
Comments
Comments
Observation End time

Anonymous

Behavioral Safety Observation

Behavior observation to ensure correct isolation of equipment prior to performing a task inside machine guarding.

Use this Template

Print as PDF

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