DTZ Corn Milling Behavior Based Safety Observation - No Name / No Blame

• Observer:

• Company:

• Conducted on:

  Date
• Location
  Address

Information

• Observer:

• Company:

• Coached by:

• # of People Observed:

• Dept. Observed:

• Company Observed:

• Select date

  Date

• Hours into Shift:

  0-4

  4-8

  8-12

  12-16

• Shift:

  Day

  Night

• Task of Month:

  Yes

  No

• Process Condition:

  Normal

  Start-up / Shutdown

  Maintenance

  Construction

W.H.A.T

• SIF Potential:

  Yes

  No

• Self Observation

  Yes

  No

Body Position

• 1.01 Line of Fire

  Safe

  At Risk

  N/A

• 1.02 Pinch Points

  Safe

  At Risk

  N/A

• 1.03 Eyes on Task / Path

  Safe

  At Risk

  N/A

Body Use / Ergonomics

• 2.01 Lifting / Twisting Mechanics

  Safe

  At Risk

  N/A

• 2.02 Work Pace / Assistance

  Safe

  At Risk

  N/A

• 2.03 Force & Exertion / Repetition

  Safe

  At Risk

  N/A

Tools & Equipment

• 3.01 Equipment Use

  Safe

  At Risk

  N/A

• 3.02 Tool Selection, Condition, Use

  Safe

  At Risk

  N/A

Procedures

• 4.01 P.J.H.A / W.H.A.T

  Safe

  At Risk

  N/A

• 4.02 Rail or Mobile Equipment Use

  Safe

  At Risk

  N/A

• 4.03 Elevated Work

  Safe

  At Risk

  N/A

• 4.04 Lockout / Tagout

  Safe

  At Risk

  N/A

• 4.05 Confined Space

  Safe

  At Risk

  N/A

• 4.06 Communication of Hazard / Permit

  Safe

  At Risk

  N/A

• 4.07 Hot Work

  Safe

  At Risk

  N/A

Food Safety

• 5.01 FS Process & Equipment Operation

  Safe

  At Risk

  N/A

• 5.02 FS Sanitary & Hygenic

  Safe

  At Risk

  N/A

• 5.03 FS Personnel Behaviors

  Safe

  At Risk

  N/A

PPE

• 6.01 Standard PPE

  Safe

  At Risk

  N/A

• 6.02 Specialized PPE

  Safe

  At Risk

  N/A

Work Environment

• 7.01 Walking / Working Surfaces

  Safe

  At Risk

  N/A

• 7.02 Housekeeping / Storage

  Safe

  At Risk

  N/A

• 7.03 Barricades / Guards

  Safe

  At Risk

  N/A

• 7.04 Ascending / Descending

  Safe

  At Risk

  N/A

• 7.05 Temperature Extremes / Weather

  Safe

  At Risk

  N/A

• 7.06 Lighting

  Safe

  At Risk

  N/A

Safe Comment - Identify notable safe behaviors

• CBI#

• WHILE and where

• WHAT the employee did to remain safe

At-Risk Comments

• CBI#

• WHILE and where

• WAS and potential hazard

• BECAUSE

• SOLUTION

• Solution from employee?

  Yes

  No

  N/A

• TRY the solution?

  Yes

  No

  N/A

• Barrier Removed?

  Yes

  No

  N/A

• If impossible to do safely, what will be done in the meantime?

• Aware of Behavior?

  Yes

  No

  N/A

• Follow-up?

  Yes

  No

• Behavior:

  Easy

  Hard

  Impossible

At-Risk Comments

• CBI#

• WHILE and where

• WAS and potential hazard

• BECAUSE

• SOLUTION

• Solution from employee?

  Yes

  No

  N/A

• TRY the solution?

  Yes

  No

  N/A

• Barrier Removed?

  Yes

  No

  N/A

• If impossible to do safely, what will be done in the meantime?

• Aware of Behavior?

  Yes

  No

  N/A

• Follow-up?

  Yes

  No

• Behavior:

  Easy

  Hard

  Impossible