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Safety Interaction
Safety Interaction
Maicah Faith Sutare

Safety Interaction Checklist

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Free Safety Interaction Checklist

Use this Digital Checklist

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Audit

Select date

Observer Name:

Employee's Dept.:

Employee's Type:

site:

Location:

Observation Condition:

NORMAL

SHUTDOWN

BREAKDOWN

Has the employee been observed by someone else this month?:

TASK DESCRIPTION:

Can you tell me about your task:

What are the main hazards/risks associated with this task?

what controls do you have in place and do you think they are enough?

What are the controls do you have in place and do you think they are enough?

What are the current health and safety issues your department experiencing?

How are these issues/concerns being addressed?

On this job, do you feel there may be a need to deviate from standard procedure?

BEHAVIOR

BODY POSITION

Line of Fire

quick notes:

Eyes on Path

quick notes:

Ascending / Descending

quick notes:

Pinch Points/ Rotating Objects

quick notes:

MANUAL/ HANDLING ERGONOMICS

Lifting/ Lowering

quick notes:

Twisting

quick notes:

Pushing / Pulling

quick notes:

Posture ? Overextended / Cramped

quick notes:

Response to Ergonomics Risk

quick notes:

TOOLS AND EQUIPMENT

Tool/Equipment Selection

quick notes:

Tool/Equipment Condition

quick notes:

Guarding/Barricades/Delineation

quick notes:

PROCEDURES:

Take 5/JHA/Project

quick notes:

Isolation / Tag- out

quick notes:

Communication of a Hazards

quick notes:

Permits

quick notes:

Light Vehicle Operations

quick notes:

Surface Mobile Equipment

quick notes:

Lifting Equipment

quick notes:

Explosives

quick notes:

Work at Height

quick notes:

Confined Space Entry

quick notes:

WORK ENVIRONMENT

Walking / Working Surfaces

quick notes:

Housekeeping/ Storage

quick notes:

Lighting

quick notes:

Temperature Extremes / UVR Exposure

quick notes:

Liquid Transfer / Uncontrolled Discharge

quick notes:

Hazardous Materials/ Noise Dust

quick notes:

PPE

Basic PPE

quick notes:

Task Specific PPE

quick notes:

Fatigue Management

quick notes:

TRAINING COMPETENCY

Check training and attach for every 10th interaction conducted.

quick notes:

POSITIVE FEEDBACK NOTES

AT- RISK BEHAVIOR NOTES

What WAS the at-risk behavior observed?

2.

3.

Was the employee AWARE of the at-risk behavior?

2.

3.

Does the employee AGREE that it is/was at-risk?

2.

3.

What is the employee's REASON behind working at-risk?

2.

3.

What is the agreed on suggestion for a SOLUTION?

2.

3.

immediate Actions:

Completed:

Corrective Actions:

Responsible Person:

Due date:

Safety Interaction
Maicah Faith Sutare

Safety Interaction

Use this Digital Checklist
Download as PDF
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.

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