Title Page
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Safety Buddy:
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Observer:
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Conducted on
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Line/Equipment ID
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What did you observe?
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Where did it happen?
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Mark each of the following behaviors as SAFE or AT RISK
Top 3 Behaviors to observe for Bakery
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Colleague has met with Safety Buddy and understands how to do a BOS?
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Colleague knows where emergency equipment is located. (Eyewash, fire extinguisher, exits for example)
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Colleague knows last safety talk or topic?
ERGONOMICS
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Colleague uses the right tool(s) for the job to avoid repetition or overexertion
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Colleague uses appropriate techniques when lifting or carrying
PPE
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Colleague stores and uses PPE as indicated in the area/activity and in its original condition
WORKPLACE ENVIRONMENT
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Colleague keeps his/her workstation in order
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Colleague keeps area clear of slip, trip or fall hazards
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Colleague uses the pedestrian walkways in the facility
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Colleague holds the handrails or keeps 3 points of contact ascending/descending (stairs, stepladders, etc)
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Colleague is aware of and safely uses chemical substances in this work area
RISK AWARENESS
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Colleague knows the hazards and risks of the workplace and properly uses a Safety Map
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Colleague properly engages QRP or permit to work tools when appropriate
POWERED INDUSTRIAL EQUIPMENT (PIE)
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Colleague operates equipment correctly without presenting new hazards (observes speed limits, seat belts, horns, etc)
LOTO
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Colleague adequately applies LOTO and carries personal locks
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Colleague operates machines with guards in placey
OTHER
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Anything thing else observed or discussed?
Step 2. Provide Feedback, encourage action and thank your colleague
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Describe the feedback you shared. Was it well received?
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Any actions recommended or taken (defect card, Kaizen, Recognition card)?
