Title Page
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Site/Plant
- CEM Turňa
- TAP 200
- Claypit area
- CEM Rohožník
- baňa Fortuna
- public road
- other
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Place
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Conducted on
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Prepared by
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Observed person:
Behavior Observation Checklist
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He/she does continue working (reaction to observation)
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He/she didn't re-arrange job (reaction to observation)
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He/she didn't hide and didn't dodge (reaction to observation)
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He/she didn't performed lockout (reaction to observation)
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He/she didn't change position (reaction to observation)
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He/she didn't change tool (reaction to observation)
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He/she didn't adjusted required PPE (reaction to observation)
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Eyes/Face protection on (PPE)
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Head protection on (PPE)
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Ears protection on (PPE)
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Respiratory system on (PPE)
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Body protection on (PPE)
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Harness/ fall protection on (PPE)
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Legs/feet protection on (PPE)
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He/she couldn't be hit by an object (working position)
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He/she couldn't fall (working position)
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He/she couldn't be in contact with extreme temperature (working position)
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He/she couldn't inhal, absorb or swallow hazardous substances (working position)
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He/she couldn't be impact by electric current
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He/she didn't perform repetitive movements (working position)
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He/she didn't use excessive force (working position)
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He/she used tools in good shape (tools and equipment)
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He/she used tools correctly (tools and equipment)
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He/she used tools/material suitable for job (tools and equipment)
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Procedure or standards established (procedures and policies)
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Procedure or standards known and understood (procedures and policies)
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Procedure or standards followed (procedures and policies)
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Procedure or standards adequate (procedures and policies)
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Risk Assesment in place
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Risk known and understood
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Related to 16 Life Saving Rules
- Contractor Management
- Machinery Safety
- Energy Isolation
- Electrical Safety
- Site Transport / Rail / Trepass
- Forklift Safety
- Mobile Phone
- Haulier Safety
- Construction Project Safety
- Road Surfacing / Repair
- Lifting Operations
- Work at Height / Falling Objects / Water
- Confined Space Work
- Lone / Remote working
- Explosive Safety
- Process Safety (Overpressurisation, Hot Material, Fire, Storage, Handling, Hazardous Material )
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Briefly describe the incident or observation
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Proposed action:
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Photo:
