Trane Mid-America EHS Observation Form

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Behavior Observation Checklist

• Risk identification and task control for tasks performed.

  Yes

  No

  N/A

• Control of job site hazards both chemical and physical.

  Yes

  No

  N/A

• Protective means used, in place, readily available.

  Yes

  No

  N/A

• Personal protective equipment utilization.

  Yes

  No

  N/A

• Focus Item: Control of hazardous energy and NFPE 70E compliance.

  Yes

  No

  N/A

• Focus Item: Uniform compliance

  Yes

  No

  N/A

Behavior Observation Coaching

• Positive reinforcing feedback

  Yes

  No

  N/A

• Behavior modification feedback.

  Yes

  No

  N/A

• Items for follow up, or actions taken.

  Yes

  No

  N/A