TVA Peer-to-peer OBSERVATIONS Checklist

Observer Information

OBSERVER INFORMATION

Observer ID #
Select date
Number of People Observed:
Coached:
WORK GROUP

PLEASE EMAIL / SCAN / FAX / TEXT TO:

Rodney Smith / WEST - FAX (423) 751-9697 PHONE (423) 653-8320 rjsmith0@tva.gov
Jeff Burcham / WEST - PHONE (423) 702 1015 jgburcham1@tva.gov
Wayne Crisp / EAST - FAX (423) 751-9818 PHONE (423) 280-4180 swcrisp@tva.gov
Lou Johnson / EAST - PHONE (423) 664-2469 lejohnson0@tva.gov

Body Position

1.0 BODY POSITION

1.1 LINE OF FIRE :
(Does the person place all parts of their body so they will not be pinned, crushed, struck, sprayed or trapped by energy release of any kind?)
Aware
Agree
Control
WHILE : Describes clearly the task or situation.
WAS (At-Risk) : Describes clearly the potential injury.
BECAUSE : Describes clearly the barrier or obstacle to doing the behavior safely.
SUGGESTION : Are solutions offered.
COMMITMENT : What the employee intends to do differently in the future.
1.2 PINCH POINTS :
(Does the person keep body parts from area between stationary or moving parts that are closing or might close together?)
Aware
Agree
Control
WHILE : Describes clearly the task or situation.
WAS (At-Risk) : Describes clearly the potential injury.
BECAUSE : Describes clearly the barrier or obstacle to doing the behavior safely.
SUGGESTION : Are solutions offered.
COMMITMENT : What the employee intends to do differently in the future.
1.3 EYES ON PATH :
(Does the person look in the direction they are moving, walking, cycling, operating mobile equipment?)
Aware
Agree
Control
WHILE : Describes clearly the task or situation.
WAS (At-Risk) : Describes clearly the potential injury.
BECAUSE : Describes clearly the barrier or obstacle to doing the behavior safely.
SUGGESTION : Are solutions offered.
COMMITMENT : What the employee intends to do differently in the future.
1.4 EYES ON TASK / HANDS :
(Does the person keep their eyes on the work being performed?)
Aware
Agree
Control
WHILE : Describes clearly the task or situation.
WAS (At-Risk) : Describes clearly the potential injury.
BECAUSE : Describes clearly the barrier or obstacle to doing the behavior safely.
SUGGESTION : Are solutions offered.
COMMITMENT : What the employee intends to do differently in the future.
1.5 Ascending / DESCENDING :
(When ascending / descending steep stairs and ladders does the person face stairs / ladder and maintain three-point contact?)
Aware
Agree
Control
WHILE : Describes clearly the task or situation.
WAS (At-Risk) : Describes clearly the potential injury.
BECAUSE : Describes clearly the barrier or obstacle to doing the behavior safely.
SUGGESTION : Are solutions offered.
COMMITMENT : What the employee intends to do differently in the future.

Body Use / Ergonomics

2.0 BODY USE / ERGONOMICS

2.1 LIFTING AND LOWERING :
(Does the person use legs and keep back straight.)
Aware
Agree
Control
WHILE : Describes clearly the task or situation.
WAS (At-Risk) : Describes clearly the potential injury.
BECAUSE : Describes clearly the barrier or obstacle to doing the behavior safely.
SUGGESTION : Are solutions offered.
COMMITMENT : What the employee intends to do differently in the future.
2.2 TWISTING :
(Does the person pivot feet to keep upper torso aligned with legs when doing task?)
Aware
Agree
Control
WHILE : Describes clearly the task or situation.
WAS (At-Risk) : Describes clearly the potential injury.
BECAUSE : Describes clearly the barrier or obstacle to doing the behavior safely.
SUGGESTION : Are solutions offered.
COMMITMENT : What the employee intends to do differently in the future.
2.3 PUSHING / PULLING :
(Does the person maintain a balanced body position while pushing / pulling?)
Aware
Agree
Control
WHILE : Describes clearly the task or situation.
WAS (At-Risk) : Describes clearly the potential injury.
BECAUSE : Describes clearly the barrier or obstacle to doing the behavior safely.
SUGGESTION : Are solutions offered.
COMMITMENT : What the employee intends to do differently in the future.
2.4 OVEREXTENDED / CRAMPED :
(Does the person position self to prevent stretching to full arm or body length when performing tasks?)
Aware
Agree
Control
WHILE : Describes clearly the task or situation.
WAS (At-Risk) : Describes clearly the potential injury.
BECAUSE : Describes clearly the barrier or obstacle to doing the behavior safely.
SUGGESTION : Are solutions offered.
COMMITMENT : What the employee intends to do differently in the future.
2.5 RESPONSE TO ERGO RISKS :
(Does the person deliberately break up the stress by changing positions, moving, stopping activity or stretching?)
Aware
Agree
Control
WHILE : Describes clearly the task or situation.
WAS (At-Risk) : Describes clearly the potential injury.
BECAUSE : Describes clearly the barrier or obstacle to doing the behavior safely.
SUGGESTION : Are solutions offered.
COMMITMENT : What the employee intends to do differently in the future.

Tools / Equipment

3.0 TOOLS / EQUIPMENT

3.1 SELECTION / CONDITION :
(Does the person select the correct tool for the job?)
Aware
Agree
Control
WHILE : Describes clearly the task or situation.
WAS (At-Risk) : Describes clearly the potential injury.
BECAUSE : Describes clearly the barrier or obstacle to doing the behavior safely.
SUGGESTION : Are solutions offered.
COMMITMENT : What the employee intends to do differently in the future.
3.2 USE :
(Is the person using the tool as it was designed to be used?)
Aware
Agree
Control
WHILE : Describes clearly the task or situation.
WAS (At-Risk) : Describes clearly the potential injury.
BECAUSE : Describes clearly the barrier or obstacle to doing the behavior safely.
SUGGESTION : Are solutions offered.
COMMITMENT : What the employee intends to do differently in the future.
3.3 Vehicle Selection :
(Is the person selecting the best vehicle for the job?)
Aware
Agree
Control
WHILE : Describes clearly the task or situation.
WAS (At-Risk) : Describes clearly the potential injury.
BECAUSE : Describes clearly the barrier or obstacle to doing the behavior safely.
SUGGESTION : Are solutions offered.
COMMITMENT : What the employee intends to do differently in the future.

Procedures

4.0 PROCEDURES

4.1 LOCKOUT / TAGOUT :
(When working on energized equipment does the employee ensure others do not have access to equipment controls and hazard zone(s)?)
Aware
Agree
Control
WHILE : Describes clearly the task or situation.
WAS (At-Risk) : Describes clearly the potential injury.
BECAUSE : Describes clearly the barrier or obstacle to doing the behavior safely.
SUGGESTION : Are solutions offered.
COMMITMENT : What the employee intends to do differently in the future.
4.3 COMMUNICATION :
(Do people communicating about work being performed and the potential hazards?)
Aware
Agree
Control
WHILE : Describes clearly the task or situation.
WAS (At-Risk) : Describes clearly the potential injury.
BECAUSE : Describes clearly the barrier or obstacle to doing the behavior safely.
SUGGESTION : Are solutions offered.
COMMITMENT : What the employee intends to do differently in the future.

PPE

5.0 PERSONAL PROTECTIVE EQUIPMENT (PPE)

5.1 HEAD :
(Is appropriate rad protection being worn for the task being performed?)
Aware
Agree
Control
WHILE : Describes clearly the task or situation.
WAS (At-Risk) : Describes clearly the potential injury.
BECAUSE : Describes clearly the barrier or obstacle to doing the behavior safely.
SUGGESTION : Are solutions offered.
COMMITMENT : What the employee intends to do differently in the future.
5.2 EYES AND FACE :
(Is the appropriate eye and face protection being worn for the task being performed?)
Aware
Agree
Control
WHILE : Describes clearly the task or situation.
WAS (At-Risk) : Describes clearly the potential injury.
BECAUSE : Describes clearly the barrier or obstacle to doing the behavior safely.
SUGGESTION : Are solutions offered.
COMMITMENT : What the employee intends to do differently in the future.
5.3 HEARING :
(Is hearing protection worn in high noise areas?)
Aware
Agree
Control
WHILE : Describes clearly the task or situation.
WAS (At-Risk) : Describes clearly the potential injury.
BECAUSE : Describes clearly the barrier or obstacle to doing the behavior safely.
SUGGESTION : Are solutions offered.
COMMITMENT : What the employee intends to do differently in the future.
5.5 HAND :
(Is the appropriate hand protection being worn for the task being performed?)
Aware
Agree
Control
WHILE : Describes clearly the task or situation.
WAS (At-Risk) : Describes clearly the potential injury.
BECAUSE : Describes clearly the barrier or obstacle to doing the behavior safely.
SUGGESTION : Are solutions offered.
COMMITMENT : What the employee intends to do differently in the future.
5.6 BODY :
(Is the person wearing body protection suitable for the task being performed?)
Aware
Agree
Control
WHILE : Describes clearly the task or situation.
WAS (At-Risk) : Describes clearly the potential injury.
BECAUSE : Describes clearly the barrier or obstacle to doing the behavior safely.
SUGGESTION : Are solutions offered.
COMMITMENT : What the employee intends to do differently in the future.
5.7 FALL :
(Is the person working at heights wearing body harness? Is it worn correctly?)
Aware
Agree
Control
WHILE : Describes clearly the task or situation.
WAS (At-Risk) : Describes clearly the potential injury.
BECAUSE : Describes clearly the barrier or obstacle to doing the behavior safely.
SUGGESTION : Are solutions offered.
COMMITMENT : What the employee intends to do differently in the future.
5.8 FOOT :
(Is appropriate foot protection for the work area being worn?)
Aware
Agree
Control
WHILE : Describes clearly the task or situation.
WAS (At-Risk) : Describes clearly the potential injury.
BECAUSE : Describes clearly the barrier or obstacle to doing the behavior safely.
SUGGESTION : Are solutions offered.
COMMITMENT : What the employee intends to do differently in the future.

Work Environment

6.0 WORK ENVIRONMENT

6.1 WALKING / WORKING SURFACE :
(Is the surface which a task is being performed stable, level, solid, and provide good traction?)
Aware
Agree
Control
WHILE : Describes clearly the task or situation.
WAS (At-Risk) : Describes clearly the potential injury.
BECAUSE : Describes clearly the barrier or obstacle to doing the behavior safely.
SUGGESTION : Are solutions offered.
COMMITMENT : What the employee intends to do differently in the future.
6.2 HOUSEKEEPING / STORAGE :
(Is the work area kept clear of debris and loose objects?)
Aware
Agree
Control
WHILE : Describes clearly the task or situation.
WAS (At-Risk) : Describes clearly the potential injury.
BECAUSE : Describes clearly the barrier or obstacle to doing the behavior safely.
SUGGESTION : Are solutions offered.
COMMITMENT : What the employee intends to do differently in the future.

9.0 OTHER

9.1 OTHER
Aware
Agree
Control
WHILE : Describes clearly the task or situation.
WAS (At-Risk) : Describes clearly the potential injury.
BECAUSE : Describes clearly the barrier or obstacle to doing the behavior safely.
SUGGESTION : Are solutions offered.
COMMITMENT : What the employee intends to do differently in the future.