PTO BMA SAFE

Gregory O'Donnell

PTO BMA SAFE

Planned Task Observation

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Use this Template

Title Page

Project
Conducted on
Team
Location
CMW's

How Many BMA SAFEs viewing for Planned Task Observation

Quantity
- 1
- 2
- 3
- 4
- 5
- 6

BMA SAFE 1

Details

BMA Safe Completed
Name
Date
Time
Job Location
Job description

FRONT OF BMA SAFE

Answered Questions 1-15
Answers appropriate to task
Where answered "Yes" to question 1 to 15, has CMW identified they can control Hazard
Has 16th Question been answered
Where CMW has answered "No" to managing a Hazard, have they contacted Supervisor and completed appropriate JSA
Where CMW has answered "Yes" to question 13 "Do I need a sub-permit" Have they contacted Supervisor and completed appropriate JSA

BACK OF BMA SAFE

Have all Hazards been transferred to Reverse side via Hazard Number
Have Appropriate Controls been put in place for each Hazard
Does CMW believe the controls effectively manage Hazards
If CMW believe the controls will not effectively manage hazard, have they contacted Supervisor to do JSA
NOTES
TAKE PHOTO OF FRONT & BACK OF BMA SAFE

BMA SAFE 1

Details

BMA Safe Completed
Name
Date
Time
Job Location
Job description

FRONT OF BMA SAFE

Answered Questions 1-15
Answers appropriate to task
Where answered "Yes" to question 1 to 15, has CMW identified they can control Hazard
Has 16th Question been answered
Where CMW has answered "No" to managing a Hazard, have they contacted Supervisor and completed appropriate JSA
Where CMW has answered "Yes" to question 13 "Do I need a sub-permit" Have they contacted Supervisor and completed appropriate JSA

BACK OF BMA SAFE

Have all Hazards been transferred to Reverse side via Hazard Number
Have Appropriate Controls been put in place for each Hazard
Does CMW believe the controls effectively manage Hazards
If CMW believe the controls will not effectively manage hazard, have they contacted Supervisor to do JSA
NOTES
TAKE PHOTO OF FRONT & BACK OF BMA SAFE

BMA SAFE 2

Details

BMA Safe Completed
Name
Date
Time
Job Location
Job description

FRONT OF BMA SAFE

Answered Questions 1-15
Answers appropriate to task
Where answered "Yes" to question 1 to 15, has CMW identified they can control Hazard
Has 16th Question been answered
Where CMW has answered "No" to managing a Hazard, have they contacted Supervisor and completed appropriate JSA
Where CMW has answered "Yes" to question 13 "Do I need a sub-permit" Have they contacted Supervisor and completed appropriate JSA

BACK OF BMA SAFE

Have all Hazards been transferred to Reverse side via Hazard Number
Have Appropriate Controls been put in place for each Hazard
Does CMW believe the controls effectively manage Hazards
If CMW believe the controls will not effectively manage hazard, have they contacted Supervisor to do JSA
NOTES
TAKE PHOTO OF FRONT & BACK OF BMA SAFE

BMA SAFE 1

Details

BMA Safe Completed
Name
Date
Time
Job Location
Job description

FRONT OF BMA SAFE

Answered Questions 1-15
Answers appropriate to task
Where answered "Yes" to question 1 to 15, has CMW identified they can control Hazard
Has 16th Question been answered
Where CMW has answered "No" to managing a Hazard, have they contacted Supervisor and completed appropriate JSA
Where CMW has answered "Yes" to question 13 "Do I need a sub-permit" Have they contacted Supervisor and completed appropriate JSA

BACK OF BMA SAFE

Have all Hazards been transferred to Reverse side via Hazard Number
Have Appropriate Controls been put in place for each Hazard
Does CMW believe the controls effectively manage Hazards
If CMW believe the controls will not effectively manage hazard, have they contacted Supervisor to do JSA
NOTES
TAKE PHOTO OF FRONT & BACK OF BMA SAFE

BMA SAFE 2

Details

BMA Safe Completed
Name
Date
Time
Job Location
Job description

FRONT OF BMA SAFE

Answered Questions 1-15
Answers appropriate to task
Where answered "Yes" to question 1 to 15, has CMW identified they can control Hazard
Has 16th Question been answered
Where CMW has answered "No" to managing a Hazard, have they contacted Supervisor and completed appropriate JSA
Where CMW has answered "Yes" to question 13 "Do I need a sub-permit" Have they contacted Supervisor and completed appropriate JSA

BACK OF BMA SAFE

Have all Hazards been transferred to Reverse side via Hazard Number
Have Appropriate Controls been put in place for each Hazard
Does CMW believe the controls effectively manage Hazards
If CMW believe the controls will not effectively manage hazard, have they contacted Supervisor to do JSA
NOTES
TAKE PHOTO OF FRONT & BACK OF BMA SAFE

BMA SAFE 3

Details

BMA Safe Completed
Name
Date
Time
Job Location
Job description

FRONT OF BMA SAFE

Answered Questions 1-15
Answers appropriate to task
Where answered "Yes" to question 1 to 15, has CMW identified they can control Hazard
Has 16th Question been answered
Where CMW has answered "No" to managing a Hazard, have they contacted Supervisor and completed appropriate JSA
Where CMW has answered "Yes" to question 13 "Do I need a sub-permit" Have they contacted Supervisor and completed appropriate JSA

BACK OF BMA SAFE

Have all Hazards been transferred to Reverse side via Hazard Number
Have Appropriate Controls been put in place for each Hazard
Does CMW believe the controls effectively manage Hazards
If CMW believe the controls will not effectively manage hazard, have they contacted Supervisor to do JSA
NOTES
TAKE PHOTO OF FRONT & BACK OF BMA SAFE

BMA SAFE 1

Details

BMA Safe Completed
Name
Date
Time
Job Location
Job description

FRONT OF BMA SAFE

Answered Questions 1-15
Answers appropriate to task
Where answered "Yes" to question 1 to 15, has CMW identified they can control Hazard
Has 16th Question been answered
Where CMW has answered "No" to managing a Hazard, have they contacted Supervisor and completed appropriate JSA
Where CMW has answered "Yes" to question 13 "Do I need a sub-permit" Have they contacted Supervisor and completed appropriate JSA

BACK OF BMA SAFE

Have all Hazards been transferred to Reverse side via Hazard Number
Have Appropriate Controls been put in place for each Hazard
Does CMW believe the controls effectively manage Hazards
If CMW believe the controls will not effectively manage hazard, have they contacted Supervisor to do JSA
NOTES
TAKE PHOTO OF FRONT & BACK OF BMA SAFE

BMA SAFE 2

Details

BMA Safe Completed
Name
Date
Time
Job Location
Job description

FRONT OF BMA SAFE

Answered Questions 1-15
Answers appropriate to task
Where answered "Yes" to question 1 to 15, has CMW identified they can control Hazard
Has 16th Question been answered
Where CMW has answered "No" to managing a Hazard, have they contacted Supervisor and completed appropriate JSA
Where CMW has answered "Yes" to question 13 "Do I need a sub-permit" Have they contacted Supervisor and completed appropriate JSA

BACK OF BMA SAFE

Have all Hazards been transferred to Reverse side via Hazard Number
Have Appropriate Controls been put in place for each Hazard
Does CMW believe the controls effectively manage Hazards
If CMW believe the controls will not effectively manage hazard, have they contacted Supervisor to do JSA
NOTES
TAKE PHOTO OF FRONT & BACK OF BMA SAFE

BMA SAFE 3

Details

BMA Safe Completed
Name
Date
Time
Job Location
Job description

FRONT OF BMA SAFE

Answered Questions 1-15
Answers appropriate to task
Where answered "Yes" to question 1 to 15, has CMW identified they can control Hazard
Has 16th Question been answered
Where CMW has answered "No" to managing a Hazard, have they contacted Supervisor and completed appropriate JSA
Where CMW has answered "Yes" to question 13 "Do I need a sub-permit" Have they contacted Supervisor and completed appropriate JSA

BACK OF BMA SAFE

Have all Hazards been transferred to Reverse side via Hazard Number
Have Appropriate Controls been put in place for each Hazard
Does CMW believe the controls effectively manage Hazards
If CMW believe the controls will not effectively manage hazard, have they contacted Supervisor to do JSA
NOTES
TAKE PHOTO OF FRONT & BACK OF BMA SAFE

BMA SAFE 4

Details

BMA Safe Completed
Name
Date
Time
Job Location
Job description

FRONT OF BMA SAFE

Answered Questions 1-15
Answers appropriate to task
Where answered "Yes" to question 1 to 15, has CMW identified they can control Hazard
Has 16th Question been answered
Where CMW has answered "No" to managing a Hazard, have they contacted Supervisor and completed appropriate JSA
Where CMW has answered "Yes" to question 13 "Do I need a sub-permit" Have they contacted Supervisor and completed appropriate JSA

BACK OF BMA SAFE

Have all Hazards been transferred to Reverse side via Hazard Number
Have Appropriate Controls been put in place for each Hazard
Does CMW believe the controls effectively manage Hazards
If CMW believe the controls will not effectively manage hazard, have they contacted Supervisor to do JSA
NOTES
TAKE PHOTO OF FRONT & BACK OF BMA SAFE

BMA SAFE 1

Details

BMA Safe Completed
Name
Date
Time
Job Location
Job description

FRONT OF BMA SAFE

Answered Questions 1-15
Answers appropriate to task
Where answered "Yes" to question 1 to 15, has CMW identified they can control Hazard
Has 16th Question been answered
Where CMW has answered "No" to managing a Hazard, have they contacted Supervisor and completed appropriate JSA
Where CMW has answered "Yes" to question 13 "Do I need a sub-permit" Have they contacted Supervisor and completed appropriate JSA

BACK OF BMA SAFE

Have all Hazards been transferred to Reverse side via Hazard Number
Have Appropriate Controls been put in place for each Hazard
Does CMW believe the controls effectively manage Hazards
If CMW believe the controls will not effectively manage hazard, have they contacted Supervisor to do JSA
NOTES
TAKE PHOTO OF FRONT & BACK OF BMA SAFE

BMA SAFE 2

Details

BMA Safe Completed
Name
Date
Time
Job Location
Job description

FRONT OF BMA SAFE

Answered Questions 1-15
Answers appropriate to task
Where answered "Yes" to question 1 to 15, has CMW identified they can control Hazard
Has 16th Question been answered
Where CMW has answered "No" to managing a Hazard, have they contacted Supervisor and completed appropriate JSA
Where CMW has answered "Yes" to question 13 "Do I need a sub-permit" Have they contacted Supervisor and completed appropriate JSA

BACK OF BMA SAFE

Have all Hazards been transferred to Reverse side via Hazard Number
Have Appropriate Controls been put in place for each Hazard
Does CMW believe the controls effectively manage Hazards
If CMW believe the controls will not effectively manage hazard, have they contacted Supervisor to do JSA
NOTES
TAKE PHOTO OF FRONT & BACK OF BMA SAFE

BMA SAFE 3

Details

BMA Safe Completed
Name
Date
Time
Job Location
Job description

FRONT OF BMA SAFE

Answered Questions 1-15
Answers appropriate to task
Where answered "Yes" to question 1 to 15, has CMW identified they can control Hazard
Has 16th Question been answered
Where CMW has answered "No" to managing a Hazard, have they contacted Supervisor and completed appropriate JSA
Where CMW has answered "Yes" to question 13 "Do I need a sub-permit" Have they contacted Supervisor and completed appropriate JSA

BACK OF BMA SAFE

Have all Hazards been transferred to Reverse side via Hazard Number
Have Appropriate Controls been put in place for each Hazard
Does CMW believe the controls effectively manage Hazards
If CMW believe the controls will not effectively manage hazard, have they contacted Supervisor to do JSA
NOTES
TAKE PHOTO OF FRONT & BACK OF BMA SAFE

BMA SAFE 4

Details

BMA Safe Completed
Name
Date
Time
Job Location
Job description

FRONT OF BMA SAFE

Answered Questions 1-15
Answers appropriate to task
Where answered "Yes" to question 1 to 15, has CMW identified they can control Hazard
Has 16th Question been answered
Where CMW has answered "No" to managing a Hazard, have they contacted Supervisor and completed appropriate JSA
Where CMW has answered "Yes" to question 13 "Do I need a sub-permit" Have they contacted Supervisor and completed appropriate JSA

BACK OF BMA SAFE

Have all Hazards been transferred to Reverse side via Hazard Number
Have Appropriate Controls been put in place for each Hazard
Does CMW believe the controls effectively manage Hazards
If CMW believe the controls will not effectively manage hazard, have they contacted Supervisor to do JSA
NOTES
TAKE PHOTO OF FRONT & BACK OF BMA SAFE

BMA SAFE 5

Details

BMA Safe Completed
Name
Date
Time
Job Location
Job description

FRONT OF BMA SAFE

Answered Questions 1-15
Answers appropriate to task
Where answered "Yes" to question 1 to 15, has CMW identified they can control Hazard
Has 16th Question been answered
Where CMW has answered "No" to managing a Hazard, have they contacted Supervisor and completed appropriate JSA
Where CMW has answered "Yes" to question 13 "Do I need a sub-permit" Have they contacted Supervisor and completed appropriate JSA

BACK OF BMA SAFE

Have all Hazards been transferred to Reverse side via Hazard Number
Have Appropriate Controls been put in place for each Hazard
Does CMW believe the controls effectively manage Hazards
If CMW believe the controls will not effectively manage hazard, have they contacted Supervisor to do JSA
NOTES
TAKE PHOTO OF FRONT & BACK OF BMA SAFE

BMA SAFE 1

Details

BMA Safe Completed
Name
Date
Time
Job Location
Job description

FRONT OF BMA SAFE

Answered Questions 1-15
Answers appropriate to task
Where answered "Yes" to question 1 to 15, has CMW identified they can control Hazard
Has 16th Question been answered
Where CMW has answered "No" to managing a Hazard, have they contacted Supervisor and completed appropriate JSA
Where CMW has answered "Yes" to question 13 "Do I need a sub-permit" Have they contacted Supervisor and completed appropriate JSA

BACK OF BMA SAFE

Have all Hazards been transferred to Reverse side via Hazard Number
Have Appropriate Controls been put in place for each Hazard
Does CMW believe the controls effectively manage Hazards
If CMW believe the controls will not effectively manage hazard, have they contacted Supervisor to do JSA
NOTES
TAKE PHOTO OF FRONT & BACK OF BMA SAFE

BMA SAFE 2

Details

BMA Safe Completed
Name
Date
Time
Job Location
Job description

FRONT OF BMA SAFE

Answered Questions 1-15
Answers appropriate to task
Where answered "Yes" to question 1 to 15, has CMW identified they can control Hazard
Has 16th Question been answered
Where CMW has answered "No" to managing a Hazard, have they contacted Supervisor and completed appropriate JSA
Where CMW has answered "Yes" to question 13 "Do I need a sub-permit" Have they contacted Supervisor and completed appropriate JSA

BACK OF BMA SAFE

Have all Hazards been transferred to Reverse side via Hazard Number
Have Appropriate Controls been put in place for each Hazard
Does CMW believe the controls effectively manage Hazards
If CMW believe the controls will not effectively manage hazard, have they contacted Supervisor to do JSA
NOTES
TAKE PHOTO OF FRONT & BACK OF BMA SAFE

BMA SAFE 3

Details

BMA Safe Completed
Name
Date
Time
Job Location
Job description

FRONT OF BMA SAFE

Answered Questions 1-15
Answers appropriate to task
Where answered "Yes" to question 1 to 15, has CMW identified they can control Hazard
Has 16th Question been answered
Where CMW has answered "No" to managing a Hazard, have they contacted Supervisor and completed appropriate JSA
Where CMW has answered "Yes" to question 13 "Do I need a sub-permit" Have they contacted Supervisor and completed appropriate JSA

BACK OF BMA SAFE

Have all Hazards been transferred to Reverse side via Hazard Number
Have Appropriate Controls been put in place for each Hazard
Does CMW believe the controls effectively manage Hazards
If CMW believe the controls will not effectively manage hazard, have they contacted Supervisor to do JSA
NOTES
TAKE PHOTO OF FRONT & BACK OF BMA SAFE

BMA SAFE 4

Details

BMA Safe Completed
Name
Date
Time
Job Location
Job description

FRONT OF BMA SAFE

Answered Questions 1-15
Answers appropriate to task
Where answered "Yes" to question 1 to 15, has CMW identified they can control Hazard
Has 16th Question been answered
Where CMW has answered "No" to managing a Hazard, have they contacted Supervisor and completed appropriate JSA
Where CMW has answered "Yes" to question 13 "Do I need a sub-permit" Have they contacted Supervisor and completed appropriate JSA

BACK OF BMA SAFE

Have all Hazards been transferred to Reverse side via Hazard Number
Have Appropriate Controls been put in place for each Hazard
Does CMW believe the controls effectively manage Hazards
If CMW believe the controls will not effectively manage hazard, have they contacted Supervisor to do JSA
NOTES
TAKE PHOTO OF FRONT & BACK OF BMA SAFE

BMA SAFE 5

Details

BMA Safe Completed
Name
Date
Time
Job Location
Job description

FRONT OF BMA SAFE

Answered Questions 1-15
Answers appropriate to task
Where answered "Yes" to question 1 to 15, has CMW identified they can control Hazard
Has 16th Question been answered
Where CMW has answered "No" to managing a Hazard, have they contacted Supervisor and completed appropriate JSA
Where CMW has answered "Yes" to question 13 "Do I need a sub-permit" Have they contacted Supervisor and completed appropriate JSA

BACK OF BMA SAFE

Have all Hazards been transferred to Reverse side via Hazard Number
Have Appropriate Controls been put in place for each Hazard
Does CMW believe the controls effectively manage Hazards
If CMW believe the controls will not effectively manage hazard, have they contacted Supervisor to do JSA
NOTES
TAKE PHOTO OF FRONT & BACK OF BMA SAFE

BMA SAFE 6

Details

BMA Safe Completed
Name
Date
Time
Job Location
Job description

FRONT OF BMA SAFE

Answered Questions 1-15
Answers appropriate to task
Where answered "Yes" to question 1 to 15, has CMW identified they can control Hazard
Has 16th Question been answered
Where CMW has answered "No" to managing a Hazard, have they contacted Supervisor and completed appropriate JSA
Where CMW has answered "Yes" to question 13 "Do I need a sub-permit" Have they contacted Supervisor and completed appropriate JSA

BACK OF BMA SAFE

Have all Hazards been transferred to Reverse side via Hazard Number
Have Appropriate Controls been put in place for each Hazard
Does CMW believe the controls effectively manage Hazards
If CMW believe the controls will not effectively manage hazard, have they contacted Supervisor to do JSA
NOTES
TAKE PHOTO OF FRONT & BACK OF BMA SAFE

PTO BMA SAFE

Gregory O'Donnell

PTO BMA SAFE

Planned Task Observation

Use this Template

Print as PDF

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.

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