• Location

  • Line Of Business

  • Is this a Safety Observation or Suggestion

  • Please describe your safety Suggestion.

  • Add media

  • SOS -Steps to Observing
    1. Pick a work task(s) or employee to observe
    2. Spend 15-30 min observing the work task(s) or employee
    3. Comment on the safe work practices
    4. Comment on the unsafe work practices
    5. Discuss and agree on safe work practices
    6. Discuss other safety concerns
    7. Complete SOS Form

  • Number of employees Observed

  • Task Observed

  • list any joint observers

  • Check items below found to be unsafe, otherwise mark “All Safe”

P.P.E. Are all employees wearing the appropriate PPE.

  • All Safe

  • Eyes & Face

  • Please describe.

  • Head

  • Please describe.

  • Hands

  • Please Describe

  • Body/Legs/Arms

  • Please describe

  • Feet

  • Please describe.

  • Other

  • Describe what PPE is missing

  • Add media

Worker Attitude

  • All Safe

  • Rushing

  • Please describe.

  • Complacent

  • Please describe

  • Frustration

  • Please describe

  • Fatigue

  • Please describe

  • Other

  • Please describe the attitude that is unsafe.

  • Add media

Safe Work & Position

  • All Safe

  • Driving

  • Please describe

  • Line of Fire (Pinch Point, Struck by, Etc.)

  • Please describe

  • Fire (Electrical, Gas, Chemical, etc.)

  • Please describe

  • Working off balance or in awkward position

  • Please describe

  • Use of mobile equipment

  • Please describe

  • Walking/Working surfaces (Slips,Trips Falls)

  • Please describe

  • Ergonomics (Lifting, Twisting, Bending, Over Exertion)

  • Please describe

  • Chemical use

  • Please describe

  • Other

  • Please describe

  • Add media

Tools & Equipment

  • All Safe

  • Right tool used for the task

  • Please describe

  • Tool used for its intended purpose

  • Please describe

  • Condition of tools

  • Please describe

  • Safety items (First aid kit/fire extinguisher)

  • Please describe

  • Right equipment for the task

  • Please describe

  • Other

  • Please describe

  • Add media

Safe Observations Discussed

  • Please List the safe work observation made and discussed

Unsafe work Observations discussed

  • Please list unsafe observations made and discussed

Corrective Actions

  • Please list any corrective actions made or that need to be made

  • Add media

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. Any ratings or scores displayed in our Public Library have not been verified by SafetyCulture for accuracy. Users of our platform may provide a rating or score that is incorrect or misleading. You should independently determine whether the template is suitable for your circumstances. You can use our Public Library to search based on criteria such as industry and subject matter. Search results are based on their relevance to your search and other criteria. We may feature checklists based on subject matters we think may be of interest to our customers.