• Job number:

  • Job Site or Title:

  • Specific location of observation: (i.e. Lay-down yard, BSL, ? Bridge, ? Building)

  • Use The Following Choices For The Observation

  • EE = Exceeds Expectations. ME = Meets Expectations. NI = needs Improvement.

Human Performance Tools

  • Plan of the Day or Job Safety Analysis or Pre/Post Job Brief

  • Verification (Self or Peer Check)

  • Crew discussion of the scope of the work assigned for the day

  • Procedure adherence and use

Hazard Recognition

  • Line of Fire

  • Hard Barricades (concrete abutments, plywood, Cor-ply, etc)

  • Barrier Tape or Rope / Correct Signage

  • Compressed Gas or Bottles (either flammable or non-flammable)

  • Electrical Cord(s) / inspected / good condition / correct inspection color coded

  • Air hoses / Connections / Whip-checks / Pins

  • Ventilation (fresh and dust collection)

  • Tools (good condition / inspected before use / calibrated)

  • Vehicle usage procedures (aerial lift / forklift or lull)

Housekeeping and Material Conditions

  • General Housekeeping (cleanliness)

  • Combustibles (properly stored / secured, labeled)

  • Work Area (orderly and controlled)

Personnel Protective Equipment

  • Head / Hard Hat

  • Hearing

  • Eyes / Face

  • Foot

  • Hand

  • Body (coveralls, etc)

  • Respirator(s)

Fall Protection

  • Correct equipment for the work and currently inspected

  • Ladder usage / setup

  • Scaffold usage (mobile or permanent) and current inspection

  • Dropped Object Control

Manual Material Handling

  • Lifting and Carring

  • Using assistance as needed

  • Using manual mechanical assistance (hand-trucks, dollys, pallet jack, etc)

Lifting and Rigging / Mechanical Material Handling

  • Operator

  • Signal Person

  • Use of Spotter(s)

  • Lift area

  • Load control

  • Softners

  • Cribbing

  • Lay-down yard (clean, uncluttered, easy access)

  • You Must Answer Both Of These Questions

  • Was feedback given to the crew or individual as soon as or during the observation

  • Was supervision debriefed while the observation was being conducted

  • Comments: ( NI = Requires a comment)

  • Comment 1:

  • Comment 2:

  • Comment 3:

  • Comment 4:

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