Meaningful Observations

• Client / Customer Site

• Conducted on

  Date

• Prepared by

• Personnel Observed

• Equipment Observed

Meaningful Observations

Housekeeping

• Aisles/Walkways kept clear?

  Safe

  At Risk

  N/A

• Housekeeping: spills, cords or other trips, trash/clutter, lighting, or Flammables

• Work area kept organized?

  Safe

  At Risk

  N/A

• Are Trash Cans available and in use?

  Yes

  No

  N/A

Personal Protective Equipment

• Personal protective equipment: hand, body, eyes/face, head, foot, respiratory, fall protection, hearing protection, or FR clothing/gear

• PPE kept in good condition?

  Safe

  At Risk

  N/A

Working Position

• Working Position: poor posture, over stretched, above shoulder, below knees, twisting, caught in between, struck by, working at heights greater than 4', floor or wall opening, unprotected work edge, or false ceiling or floor.

• Body position

  Safe

  At Risk

  N/A

• Location in working environment

  Safe

  At Risk

  N/A

Tools and Equipment

• Tools and equipment: ladders, power or hand tools

• Tools or equipment being used correctly?

  Safe

  At Risk

  N/A

• Tools or equipment in good condition?

  Safe

  At Risk

  N/A

Safe behaviors observed

Unsafe behaviors observed

Line of fire observations

• Water Blasting creating flying debris?

• Vacuuming Operations creating static charge?

• Pinch Points?

Actions taken

Safety procedures

• GSP # 1, lock Out / Tag out

  Safe

  At Risk

  N/A

• GSP # 2, Confined Space Entry

  Safe

  At Risk

  N/A

• GSP # 3, Fall Protection

  Safe

  At Risk

  N/A

• GSP # 4, Wet / Dry Vacuum Operation

  Safe

  At Risk

  N/A

• GSP # 5, Waterblasting Operation

  Safe

  At Risk

  N/A

• Add media

  Media

• Observers Signature:

  Sign