General Information
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Jobsite Name
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Conducted On
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Prepared By
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Jobsite Location
Observation Details
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Category of Observation
- Access
- Air Quality [Silica Dust / Respiratory Protection / Monitoring]
- Crane / Rigging / Signalman Operation
- Electrical
- Excavation / Opening / Trench
- Fall Protection
- Fire Protection
- Hazard Communication / SDS
- Heat Illness
- Housekeeping / Sanitation
- Impalement Hazard
- Ladders / Stairways
- Lifts [Scissor lift / Boom lift / Reach / W.H. Forklift]
- LOTO [Lock Out Tag Out]
- Mobile Equipment
- Posting / Signage
- PPE [Personal Protective Equipment]
- Scaffolding
- Slip, Trip, or Fall
- Storage and Materials
- Tools / Equipment [Hand & Power Tools or Equipment]
- Traffic Control
- Welding / Cutting / Gas Cylinder Use & Storage
- Management Activities [Emergency Procedures / First Aid / JHA / Pre-Task / Jobsite Inspection]
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Type of Observation
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Risk Rating
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Action Plan Review (Multiple Choice)
- N/A (Positive Observation)
- Completed Corrective Action Plan
- Disciplinary Action Required
- Re-Training Required
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Describe the Observation in the NOTES (Attach ALL Photos)
