Safe Job Observation

• Conducted on

  Date

• Safe Job Observation

• Document No.

• Location

• Personnel Present

• Prepared by

• Location
  Address

Body Mechanics

• Is your footing or position safe? List unsafe acts observed and/or corrective actions taken.

  Safe

  At Risk

  N/A

• Is the employee using proper lifting techniques? List unsafe acts observed and/or corrective actions taken.

  Safe

  At Risk

  N/A

• Are any pinch points present? List pinch points observed and/or corrective actions taken.

  Safe

  At Risk

  N/A

• Is the employee overextending? List unsafe acts observed and/or corrective actions taken.

  Safe

  At Risk

  N/A

• Is the employee pulling or twisting while working? List unsafe acts observed and/or corrective actions taken.

  Safe

  At Risk

  N/A

Tools & Equipment

• Are the proper tools and equipment being used? List unsafe acts observed and/or corrective actions taken.

  Safe

  At Risk

  N/A

• Are the tools and/or equipment being used in good condition? List unsafe acts observed and/or corrective actions taken.

  Safe

  At Risk

  N/A

PPE

• Eye Protection

  Safe

  At Risk

  N/A

• Hand protection

  Safe

  At Risk

  N/A

• Hearing protection

  Safe

  At Risk

  N/A

• Respirator

  Safe

  At Risk

  N/A

• Clothing/FR Clothing

  Safe

  At Risk

  N/A

• Fall Protection

  Safe

  At Risk

  N/A

Operating Procedures

• Pre-job or task STOP card completed

  Yes

  No

  N/A

• Following SJP or Standard Work?

  Yes

  No

  N/A

• Chemical safety

  Safe

  At Risk

  N/A

• Housekeeping conditions?

  Safe

  At Risk

  N/A

• LO/TO required?

  Safe

  At Risk

  N/A

• Confined space entry required?

  Safe

  At Risk

  N/A

Individuals participating in observation

• Employee conducting observation

  Sign

• Employee being observed

  Sign

• Task being observed