Information
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Document No.
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PSC Observation Worksheet
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Client / Site
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Conducted on
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Prepared by
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Location
Location: (Select only one)
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Turbine building
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Aux building
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Containment
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Control Room
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Fab Shop
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Outside
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Intake
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Switch yard
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Pri / Sec Lab
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Training Center
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Other
Use The Following Choices For The Observation
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EE = Exceeds Expectations. ME = Meets Expectations. NI = Needs Improvement. UN = Un-satisfactory
Human Performance Tools
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01. STA (Safety Task Assignment) or Pre/Post Job Brief
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02. Self Checking (STAR, Flagging)
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03. Verification (Peer Check, CV, IV)
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04. Questioning Attitude (Two Min Rule, QV&V)
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05. Procedure Use and Adherence
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06. Communicate Effectively (3-Way, Phonetic Alphabet)
Hazard Recognition
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07. Line of Fire
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08. Barrier Tape / Rope
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09. Barricades
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10. Compressed Gas
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11. Electrical Cord(s)
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12. Hoses / Connections
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13. Tools
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14. Vehicles
Housekeeping and Material Conditions
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15. Housekeeping
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16. Combustibles
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17. Work / Laydown Area
Personnel Protective Equipment
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18. Head
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19. Hearing
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20. Eyes / Face
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21. Foot
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22. Hand
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23. Body (Coveralls, etc.)
Rad Worker Practices
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24. Rad Worker Practices
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25. Dosimeters Use
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26. RWP Knowledge / Adherence
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27. Contamination Control
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28. ALARA
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29. Use of Rad Monitors
Foreign Material Exclusion
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30. Boundaries / Barriers
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31. FME Log / Monitor
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32. FME Monitor
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33. Work Practices
Lifting and Rigging
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34. Softners
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35. Cribbing
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36. Lift Area
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37. Operator
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38. Signal Person
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39. Load Control
Material Handling
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40. Lifting and Carrying
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41. Use of Spotter
Fall Protection
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42. Use of Fall Protection
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43. Ladder Use
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44. Dropped Objects
You must answer both of these questions
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Feedback Given to Crew or Individual
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Debriefed Supervision
