Title Page
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Conducted on
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Observer
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Peer
Prepare:
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Demonstrates an understanding of the safety rules and practices associated with the job or situation.
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Comments:
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Models safe behavior by wearing all PPE, when required, and following applicable safe work practices.
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Comments:
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Through verbal and non-verbal communication, sets a positive tone for the interaction.
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Comments:
Give Feedback
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Achieves a proper balance of positive reinforcement, constructive feedback and collaboration.
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Comments:
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Places emphasis on Potential Serious Injury and Fatality (PSIF) exposures.
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Comments:
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Performs interaction at sufficient depth and duration to provide value.
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Comments:
Review:
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Reviews results of interaction with co-workers to make sure they understand everything that was noted.
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Comments
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Solicits, willingly accepts, and shows appreciation for feedback from contractor.
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Comments
Follow- up
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Evidence of appropriate follow- up action taken; closes the loop with contractor.
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Comments:
