Title Page
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Conducted on
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Prepared by
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Location
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Location
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Line Of Business
- ATP
- Viking
- Parts
- Body Shop
- Sales
- Office
- Service
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Is this a Safety Observation or Suggestion
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Please describe your safety Suggestion.
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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
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Task Observed
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list any joint observers
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Check items below found to be unsafe, otherwise mark “All Safe”
P.P.E. Are all employees wearing the appropriate PPE.
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All Safe
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Eyes & Face
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Please describe.
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Head
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Please describe.
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Hands
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Please Describe
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Body/Legs/Arms
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Please describe
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Feet
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Please describe.
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Other
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Describe what PPE is missing
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Worker Attitude
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All Safe
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Rushing
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Please describe.
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Complacent
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Please describe
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Frustration
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Please describe
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Fatigue
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Please describe
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Other
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Please describe the attitude that is unsafe.
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Safe Work & Position
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All Safe
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Driving
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Please describe
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Line of Fire (Pinch Point, Struck by, Etc.)
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Please describe
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Fire (Electrical, Gas, Chemical, etc.)
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Please describe
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Working off balance or in awkward position
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Please describe
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Use of mobile equipment
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Please describe
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Walking/Working surfaces (Slips,Trips Falls)
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Please describe
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Ergonomics (Lifting, Twisting, Bending, Over Exertion)
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Please describe
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Chemical use
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Please describe
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Other
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Please describe
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Tools & Equipment
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All Safe
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Right tool used for the task
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Please describe
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Tool used for its intended purpose
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Please describe
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Condition of tools
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Please describe
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Safety items (First aid kit/fire extinguisher)
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Please describe
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Right equipment for the task
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Please describe
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Other
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Please describe
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Safe Observations Discussed
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Please List the safe work observation made and discussed
Unsafe work Observations discussed
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Please list unsafe observations made and discussed
Corrective Actions
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Please list any corrective actions made or that need to be made
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