COACH Card and BBS Observation Form

• 

• Observer

• Conducted on

  Date

• Area

  Select

• Activity

  Select

• Position of Person(s)

  Safe

  At Risk

  N/A

• Line of Fire

  Safe

  At Risk

  N/A

• Struck By / Struck Against

  Safe

  At Risk

  N/A

• Caught In, On, or Between

  Safe

  At Risk

  N/A

• Fall Potential

  Safe

  At Risk

  N/A

• Manual Handling / Lifting

  Safe

  At Risk

  N/A

• Ergonomics / Awkward Position / Overexertion / Repetitive Motion

  Safe

  At Risk

  N/A

• Appropriate Behavior / Attitude / Fit-for-Duty (Conscientious, Focused, Rested, etc)

  Safe

  At Risk

  N/A

• Demonstrates Proper Skill, Training, Knowledge of Task / Safe Work Practices / Permit

  Safe

  At Risk

  N/A

Personal Protective Equipment

• Right Type For Job

  Safe

  At Risk

  N/A

• Head Protection (Hard Hat)

  Safe

  At Risk

  N/A

• Eye & Face Protection (Glasses/Goggles/Faceshield)

  Safe

  At Risk

  N/A

• Hands, Arms & Feet (Gloves/Sleeves/Safety Boots)

  Safe

  At Risk

  N/A

• Fall Protection (Body Harness / Lanyard / Anchor Point)

  Safe

  At Risk

  N/A

• Respiratory Protection

  Safe

  At Risk

  N/A

• Hearing Protection

  Safe

  At Risk

  N/A

• Special / Other (FRC, PFD, Barricade, Screens, etc.)

  Safe

  At Risk

  N/A

Technology / Tools / Equipment / Energy Control

• Pre-Use Inspection / Safe condition

  Safe

  At Risk

  N/A

• Proper Adjustment / Repair / Maintenance

  Safe

  At Risk

  N/A

• Right Type for Job / Fit-For-Purpose

  Safe

  At Risk

  N/A

• Guards / Barriers / Safety Devices / Protection systems Installed and

  Safe

  At Risk

  N/A

• Operational

  Safe

  At Risk

  N/A

• Safety of Design / Layout / Controls

  Safe

  At Risk

  N/A

• Tools/Equipment/Materials/Loads Used, Stored and Secured Properly

  Safe

  At Risk

  N/A

• Energy Control (Potential Energy, Fire/Explosion, Chemical, Thermal, Electrical, Pneumatic, Hydraulic, Radiation, etc)

  Safe

  At Risk

  N/A

Organization / Procedures

• Adequate / Effective Standards / Procedures / Permits

  Safe

  At Risk

  N/A

• Proper Supervision / Enforcement

  Safe

  At Risk

  N/A

• Safety Meetings / Safety Tailgates

  Safe

  At Risk

  N/A

• Work Instructions Understood / Means to Communicate / Hand-over

  Safe

  At Risk

  N/A

• Coordination / Control of Contractors and External Parties

  Safe

  At Risk

  N/A

• Pre-Job Hazard Identification / Risk Assessment / JSA / JHA / Updates for Changes

  Safe

  At Risk

  N/A

• Awareness of Potential Hazards / Risks - What can go wrong?

  Safe

  At Risk

  N/A

• Management of Change (MOC)

  Safe

  At Risk

  N/A

• Emergency Preparedness (Exit Routes, Alarms, etc)

  Safe

  At Risk

  N/A

Environment

• Housekeeping / Walkways / Congestion / Uneven or Slippery Surfaces / Protruding

  Safe

  At Risk

  N/A

• Weather (Extreme Temperatures, Humidity, Wind, Rain, Ice, Snow, Sand, Sea State, Natural Events)

  Safe

  At Risk

  N/A

• Contamination (Fumes, Mists, Dusts, Noise, etc.)

  Safe

  At Risk

  N/A

• Pollution Event (Air, Land, Water)

  Safe

  At Risk

  N/A

• Waste Management / Containment / Spill Prevention

  Safe

  At Risk

  N/A

• Ventilation/Lighting

  Safe

  At Risk

  N/A

• Access / Egress (Ladders, Stairs, etc)

  Safe

  At Risk

  N/A

• Error-inducing / Contributing Condition

  Safe

  At Risk

  N/A

Comments / Other

• 1.

• Safe, At Risk, N/A

  Safe

  At Risk

  N/A

• 2.

• Safe, At Risk, N/A

  Safe

  At Risk

  N/A

• 3.

• Safe, At Risk, N/A

  Safe

  At Risk

  N/A

• 4.

• Safe, At Risk, N/A

  Safe

  At Risk

  N/A

• 5.

• Safe, At Risk, N/A

  Safe

  At Risk

  N/A