Information
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Document No.
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Company being observed?
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Area/Location of Observation?
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Weather conditions?
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Select date
Visual Focus
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Eyes on task
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Eyes on walking path
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Acting to correct an observed risk
Body Position
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Hands safe
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Out of "line of Fire"
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Avoid crush or pinch points
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Maintaining balance, traction and grip
Manual Material Handling
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Bend at the knees, not waist
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Hold load close to body
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Turn at feet, not the waist
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Avoid over-reaching
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Choose pushing instead of pulling
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Lifting within power zone
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Single person lifts < 50 lbs.
Organization & Housekeeping
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Clean work area and safe path of travel
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Safe staging of materials
Elevated Work
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Adhere to ladders last policy
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Proper Anchor point and use of fall-arrest equipment
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Ladder - 3 points of contact or personal fall protection
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Observer Name(s)
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Observer Name(s)
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Observer Name(s)
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Observer Name(s)