Harlan Safe Behavior Observation

• Job Observed on

  Select

• Conducted on

  Date

• Prepared by

• Personnel Observed

• Date / Time of Observation

  Date

• Contractor Observed (if not HCC)

• Specific Location

  Select Site Work Lay Down Yard Ground Floor Elevator Shaft Stair Well 1st Floor 2nd Floor 3rd Floor 4th Floor 5th Floor Roof Basement Footing/Excavation Elevated work area

  • Site Work
  • Lay Down Yard
  • Ground Floor
  • Elevator Shaft
  • Stair Well
  • 1st Floor
  • 2nd Floor
  • 3rd Floor
  • 4th Floor
  • 5th Floor
  • Roof
  • Basement
  • Footing/Excavation
  • Elevated work area

• Insert Column Location or other Comments Here for Clarification

• Number of Employees Observed

• Observer(s)

  Select Ed Trent Kenny Jordan Steve Nash Max Harlan Jonathan Talbert Craig Doyle Armando Arturo Jose C Jose Bonilla Brandon Gerry

  • Ed Trent
  • Kenny Jordan
  • Steve Nash
  • Max Harlan
  • Jonathan Talbert
  • Craig Doyle
  • Armando
  • Arturo
  • Jose C
  • Jose Bonilla
  • Brandon
  • Gerry

Any Marked "At Risk" Must Include Details and a photo.

• Face / Eye PPE

  Safe

  At Risk

  N/A

• Foot PPE

  Safe

  At Risk

  N/A

• Hand / Arm PPE

  Safe

  At Risk

  N/A

• Head PPE

  Safe

  At Risk

  N/A

• Hearing PPE

  Safe

  At Risk

  N/A

• Respiratory PPE

  Safe

  At Risk

  N/A

• Fall Protection

  Safe

  At Risk

  N/A

• Mobile Lifts

  Safe

  At Risk

  N/A

• Electrical / GFCI

  Safe

  At Risk

  N/A

• Lockout / Tagout

  Safe

  At Risk

  N/A

• Work Permits

  Safe

  At Risk

  N/A

• Excavations

  Safe

  At Risk

  N/A

• Hot Work

  Safe

  At Risk

  N/A

• Storage Area

  Safe

  At Risk

  N/A

• Body Position

  Safe

  At Risk

  N/A

• Ladders

  Safe

  At Risk

  N/A

• Scaffolds

  Safe

  At Risk

  N/A

• Access / Egress

  Safe

  At Risk

  N/A

• Aerial Lifts

  Safe

  At Risk

  N/A

• Barricades / Signage

  Safe

  At Risk

  N/A

• Slips / Trips / Falls

  Safe

  At Risk

  N/A

• Lifting / Rigging

  Safe

  At Risk

  N/A

• Confined Space

  Safe

  At Risk

  N/A

• Equipment / Tools

  Safe

  At Risk

  N/A

• Housekeeping

  Safe

  At Risk

  N/A

• Lighting

  Safe

  At Risk

  N/A

• Chemical

  Safe

  At Risk

  N/A

• Material Handling

  Safe

  At Risk

  N/A

• Other

  Safe

  At Risk

  N/A

PTP Audit

• All Steps Identified

  Yes

  No

  N/A

• All Hazards Identified

  Yes

  No

  N/A

• All Controls Identified

  Yes

  No

  N/A

• All crew and foreman signatures in place

  Yes

  No

  N/A

• Work activities match PTP

  Yes

  No

  N/A

• Good PTP

  Yes

  No

  N/A
Corrective Action

• Detail issue

• Detail Corrective Action and owner

• Due date

  Date

• Check box if completed

• Name of Auditor and Signature

  Sign