Body Position

  • Avoids walking/working under loads

  • Excessive lifting/pushing/pulling/bending

  • In harm's way

  • Pinch points

  • Office ergonomics

  • Walking/climbing

Procedure/Policies

  • Authorization/permits to work

  • Barricades/barriers

  • Communication between workers

  • Distracted driving

  • JSA/operating procedure

  • Worker fatigue

Personal Protective Equipment

  • Eye/face protection

  • Fall protection

  • Foot/leg protection

  • Hand/arm protection

  • Hearing protection

Tools & Equipment Use

  • Condition of hoses/connections/gauges

  • Equipment selection/condition/use

  • Hand tool selection/condition/use

HSE Condition

  • HSE At-Risk Condition

  • Explain HSE impact

Description of Observation

Action Taken for At-Risk Behavior

  • Intervened and stopped act

  • Coached and corrected at-risk behavior

  • Eliminated/mitigated the hazard(s)

  • Stop Work Used

  • Requested action from HSE

Safe Behavior(s)

  • Feedback given to reinforce safe behavior(s)

  • Nominated for recognition

  • Other comments

Improvement Opportunities

Follow-up Process

  • Feedback Requested

  • Observation Closed

Sign Off

  • Auditor's signature

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