Information
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Document No.
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Building / Account
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Date & Time
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Observer
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Shift
Task Observation
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Mopping Floors
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Vacuuming
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Removing Small Trash
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Removing Large Trash
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Cleaning Rest Rooms
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Dusting
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Non-Routine Tasks
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Other - Add any other items by tapping the "Add Other" button.
Other
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Personal Protective Equipment
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Eye/Face Protection
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Hand Protection
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Foot Protection
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Dust Mask
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Apron/Smock
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Knee Pads
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Other - Add any other items by tapping the "Add Other" button.
Other
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Ergonomics
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Lifting
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Carrying
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Pulling/Pushing
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Overstress/Overexertion/Overload
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Repetitive Motion
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Other - Add any other items by tapping the "Add Other" button.
Other
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Tools and Equipment
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Proper Tool Selection
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Equipment Condition
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Properly Used
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Tool Inspection
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Other - Add any other items by tapping the "Add Other" button.
Other
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Hazard Communication / Chemical Safety
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Proper Labels
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Proper Application
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Product Awareness
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Other - Add any other items by tapping the "Add Other" button.
Other
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Observations & Corrective Actions
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Safe Behaviors Observed
Safe Behavior
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Unsafe Behaviors Observed
Unsafe Behavior
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Corrective Actions for Unsafe Behavior
Corrective Action
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Employee Feedback
Feedback
Observed Employees Names
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Employee
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Name
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Job Title
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Notes
Distribution
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Follow Up
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Corrected
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safetyreportsnen.us@dtz.com
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Safety Committee Chairperson
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Account Manager
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Supervisor
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Manager Signature
