• Area

Reaction of People

  • Adjusting PPE

  • Changing Position

  • Rearranging Job

  • Stopping Job

  • Performing Locks

  • Comments

Personal Protective Equipment and Quality Protective Equipment

  • Bump Cap

  • Steel Toe Boots

  • Safety Glasses

  • Ear Plugs

  • Sleeves

  • Respiratory System

  • Comments

Positions of People

  • Striking against or struck by objects

  • Caught in, on, or between objects

  • Falling

  • Contacting Extreme Temperatures

  • Contacting electrical current

  • Inhaling, absorbing, or swallowing a hazardous substance

  • Repetitive Motions

  • Awkward positions, static postures

  • Comments

Tools

  • Right for the job

  • Used Correctly

  • In good condition

  • Comments

Procedures

  • Available

  • Adequate

  • Known

  • Understood

  • Followed

  • Comments

Orderliness

  • Known Order

  • Understood order

  • Followed Order

  • Comments

Observation Report

Safe Acts

  • What safe acts were observed?

  • What actions were taken to encourage safe performance

Unsafe Acts

  • What unsafe acts were observed?

  • What corrective action was taken?

  • What action was taken to prevent further occurance?

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