Information
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Job Number
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Project
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Location
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Conducted on
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Personnel
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LOCATION:
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DATE & TIME OF OBSERVATION:
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TYPE OF WORK BEING OBSERVED:
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NUMBER OF PEOPLE BEING OBSERVED:
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
- 11
- 12
- 13
- 14
- 15
- 19
- 20
- >20
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CRAFT BEING OBSERVED
- Ironworker
- Boilermaker
- Laborer
- Carpenter
- Cement Finisher
- Pipefitter
- Operator
- Electrician
- Painter
- Insulator
- Other
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EQUIPMENT BEING WORKED ON:
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WAS A PRE-JOB BRIEFING CONDUCTED?
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WAS "EYES ON PATH" USED DURING YOUR OBSERVATION?
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WAS "EYES ON HANDS" USED DURING YOUR OBSERVATION?
CATEGORY A - Personal Protective Equipment
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Personal work clothing is in good condition. A.1
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Personal Protective Equipment is correct for the hazard. A.2
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PPE is being used properly and is in good condition. A.3
CATEGORY B - General Awareness
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Worker is aware of, and observant of, nearby hazards. B.1
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Worker is aware of heavy equipment and demonstrates effective practices to remain clear. B.2
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Workers are focused on the task and are free of distraction. B.3
CATEGORY C - Work Practices
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Scrap material is controlled to prevent accumulations on walking and working surfaces. C.1
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Material is staged for efficiency and keeping walking and working areas clear. C.2
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Tools in use are appropriate for the task and are used correctly. C.3
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Housekeeping is maintained to provide organized and clean work areas. C.4
CATEGORY D - Procedures and Best Practices
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Pick and Carry of material, D.1
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Load is minimized. D.2
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Load handling pathway is scouted. D.3
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A spotter is used when load handler can not see pathway. D.4
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Signaling of loads is clear and visible. D.5
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Radio signaling is clear and concise when used. D.6
CATEGORY E - Communication
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All craft understand Pre-task. E.1
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All craft are provided and accept clear direction. E.2
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Workers are aware of adjacent work and have briefed others on their work. E.3
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Two-way communication is used to ensure message is correctly received. E.4
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Teamwork is evident. E.5
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Workers accept coaching. E.6
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All workers look out for each other as their Brother's Keeper. E.7
Observation Feedback
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Observation Category
- A- Personal Protective Equipment
- B- General Awareness
- C- Work Practices
- D- Procedures and Best Practices
- E- Communication
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Feedback Provided
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Observation Category
- A- Personal Protective Equipment
- B- General Awareness
- C- Work Practices
- D- Procedures and Best Practices
- E- Communication
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Feedback Provided
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Observation Category
- A- Personal Protective Equipment
- B- General Awareness
- C- Work Practices
- D- Procedures and Best Practices
- E- Communication
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Feedback Provided
Pre-Incident Learning Questions
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How can someone get hurt doing this task? How have we avoided that?
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Have you experienced or heard of recent close calls? What happened? What did we do about it?
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What is your biggest safety concern on this job?
