Safety Observation - Short Form

• Site

• Location
  Address

• Company

• Conducted On

  Date

• Conducted By

Description

• What task(s) was observed?

• No. of people observed?

• Duration of observation?

  => 15 minutes

  => 30 minutes

  =>45 minutes

  => 60 minutes

Observation Type

• PPE - Personal Protective Equipment

• LT - Leadership, Initiative & Teamwork

• ERG - Ergonomics

• TE - Tools & Equipment

• PRO - Procedures, Protocols & Work Practices

• HOU - Housekeeping & Organization

• SEC - Security

• OTH - Other

• Please Describe

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

• Please Describe Findings

  Positive

  Negative

• Please Explain

Observation Verification

• Reviewer

  Sign

• Observed Employee(s) or Contractor(s)

  Sign