Team Observation Checklist

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Area:

• Crew:

• Type of work:

• Select date

  Date

Body Position

• Line of fire

  Safe

  At Risk

  N/A

• Crush points

  Safe

  At Risk

  N/A

• Overreaching

  Safe

  At Risk

  N/A

• Balance, traction, grip

  Safe

  At Risk

  N/A

Attention to work

• Mentally engaged

  Safe

  At Risk

  N/A

• Distracted

  Safe

  At Risk

  N/A

• Rushing

  Safe

  At Risk

  N/A

Personal Protective Equipment

• PPE Available

  Safe

  At Risk

  N/A

• All PPE worn properly

  Safe

  At Risk

  N/A

• PPE in good condition

  Safe

  At Risk

  N/A

Executing Work

• Using tools and equipment

  Safe

  At Risk

  N/A

• Following safety procedure

  Safe

  At Risk

  N/A

• Lockout in place where needed

  Safe

  At Risk

  N/A

Working Conditions

• Condition of tools and equipment

  Safe

  At Risk

  N/A

• Housekeeping

  Safe

  At Risk

  N/A

• Guards and barriers

  Safe

  At Risk

  N/A

• Workplace design

  Safe

  At Risk

  N/A

Ergonomics

• Twisting and turning

  Safe

  At Risk

  N/A

• Stretching and micro breaks

  Safe

  At Risk

  N/A

• Wrist and hand position

  Safe

  At Risk

  N/A

• Neck and shoulder position

  Safe

  At Risk

  N/A

Employee Feedback

• Positive Reinforcement or Coaching Used

• Did the employee respond positively to feedback?

  Yes

  No

  N/A

• Maintenance required?

  Yes

  No

  N/A

• Follow up action required?

  Yes

  No

  N/A

• What action is required?

• Observer:

  Sign

• Observer:

  Sign

• Observed Employee:

  Sign