Safety Observation

• Site

  Select
• Location
  Address

• Conducted On

  Date

• Prepared By:

Description

• What task(s) was observed?

• No. of people observed?

• Duration of observation?

Observation Type

• PPE - Personal Protective Equipment

• LT - Leadership, Initiative & Teamwork

• EQP- Equipment Operation

• TE - Tools & Equipment

• PRO - Procedures, Protocols & Work Practices

• HOU - Housekeeping & Organization

• SEC - Security

• OTH - Other

Observation Class

• SA - Safe Act

• SRV - Safety Rule Violation

• RA - At Risk Act

• RC - At Risk Condition

• BIO - Business Improvement

• ET - Environmental Issue

• PRE - Positive Recognition

Observation:

• Observation Summary

Observation Verification Employee

• Observed Employee Signature:

  Sign
Observation Verification Loss Control Officer

• Loss Control Officer Signature:

  Sign