Title Page

  • Site conducted

  • Conducted on

  • Location
  • Prepared by

  • Whos Being Observed?

Arrival

  • Observes vehicle positioning, placement, parking.

  • Observes activity taking place (Climbing, Aerial Lift, etc.…)

  • Observes crew positioning upon arrival.

  • Parks in a safe place.

  • Documents Findings.

Approach

  • Attitude towards crew members/Greets crew/ Body language appropriate

  • Requests JSA, ERP, and all required documentation, and where to find it.

  • Allows for crew to approach and brief he/her on job plan break down.

  • Asks about the job plan break down.

Observation Skills

  • Observes and identifies over all activity/activities taking place.

  • Observes Correct use of PPE.

  • Observes aerial rescue kit placement.

  • Observes Fire Tool placement in relation to the site and work being performed.

  • Observes tie in points (tree and Lift).

  • Observes 2 points of attachment while using cutting tools.

  • Observes JSA matches jobsite analysis.

  • Observes Correct use of cutting tools (Handsaw, Pruner, Chainsaw)

  • Observes spotter position in relation to climber/operator aloft.

  • Observes 2 points of attachment while using cutting tools(In Tree).

  • Observes company policies and safe work practices are being followed.

  • Observes and identifies Items at risk

Conflict Resolution Skills

  • bserves company policies are being followed.

  • Stops Crew when Safe?

  • Addresses safety concern?

  • Makes crew aware of findings or exceeds?

  • References to specific training document, Policy, or ANSI Z133-2017 standard regarding items identified?

  • Communicates concerns to crew?

  • Does he/she refer on where to find specific policies and safe work procedures?

  • Explains the potential hazards associated with the items identified?

  • Explains or demonstrates proper way to perform task at risk?

  • Does crew engage in training or demonstration?

  • Documents finding on observation platform?

  • Documents training on data platform? Or sign in sheet?

  • Contacts crew supervisor regarding issue?

  • Assigns Action Item on observation platform for follow up with crew and crew supervisor?

  • Contacts his/her supervisor to report issue?

  • Comments

  • Evaluator Signature

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