Reaction of People

  • Adjusting PPE

  • Changing Position

  • Rearranging Job

  • Stopping Job

  • Attaching Grounds

  • Performing Locks

  • Comments

Personal Protective Equipment and Quality Protective Equipment

  • Head

  • Eyes and face

  • Ear Plugs

  • Respiratory System

  • Arms and hands

  • Trunk

  • Legs and feet

  • Comments

Positions of People

  • Striking against

  • Struck by Objects

  • Caught in, on, or between objects

  • Falling

  • Contacting Extreme Temperatures

  • Contacting electrical current

  • Inhaling, absorbing, or swallowing a hazardous substance

  • Overexertion

  • Repetitive Motions

  • Awkward positions, static postures

  • Comments

Tools

  • Wrong for the job

  • Used Incorrectly

  • In Unsafe condition

  • Comments

Procedures

  • Procedures Inadequate for the job

  • Procedures Not Known and Understood by all concerned

  • Procedures known and understood but Not Followed

  • Orderliness Standards Inadequate for the job

  • Orderliness Standards Not Known and Understood by all concerned

  • Orderliness Standards known and understood but Not Followed

  • 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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