Title Page
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Site conducted
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Conducted on
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Location
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Prepared by
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Whos Being Observed?
Arrival
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Observes vehicle positioning, placement, parking.
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Observes activity taking place (Climbing, Aerial Lift, etc.…)
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Observes crew positioning upon arrival.
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Parks in a safe place.
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Documents Findings.
Approach
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Attitude towards crew members/Greets crew/ Body language appropriate
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Requests JSA, ERP, and all required documentation, and where to find it.
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Allows for crew to approach and brief he/her on job plan break down.
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Asks about the job plan break down.
Observation Skills
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Observes and identifies over all activity/activities taking place.
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Observes Correct use of PPE.
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Observes aerial rescue kit placement.
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Observes Fire Tool placement in relation to the site and work being performed.
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Observes tie in points (tree and Lift).
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Observes 2 points of attachment while using cutting tools.
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Observes JSA matches jobsite analysis.
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Observes Correct use of cutting tools (Handsaw, Pruner, Chainsaw)
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Observes spotter position in relation to climber/operator aloft.
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Observes 2 points of attachment while using cutting tools(In Tree).
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Observes company policies and safe work practices are being followed.
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Observes and identifies Items at risk
Conflict Resolution Skills
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bserves company policies are being followed.
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Stops Crew when Safe?
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Addresses safety concern?
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Makes crew aware of findings or exceeds?
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References to specific training document, Policy, or ANSI Z133-2017 standard regarding items identified?
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Communicates concerns to crew?
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Does he/she refer on where to find specific policies and safe work procedures?
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Explains the potential hazards associated with the items identified?
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Explains or demonstrates proper way to perform task at risk?
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Does crew engage in training or demonstration?
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Documents finding on observation platform?
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Documents training on data platform? Or sign in sheet?
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Contacts crew supervisor regarding issue?
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Assigns Action Item on observation platform for follow up with crew and crew supervisor?
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Contacts his/her supervisor to report issue?
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Comments
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Evaluator Signature