Information
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Date
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Location or Project
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Observation Classification
- Safe Observation
- Unsafe Condition (site condition, maintenance, etc.)
- Equipment Damage
- Unsafe Behavior
- Near Miss (no damage or injuries )
- Other
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Classification Relation
- Chemical
- Biological (insects, plants, mold, bacteria, viral, etc.)
- Ergonomic (body positioning, vibrating hand tools, repetitive motion)
- Physical (hazards that don't touch you but affect you like temp extremes, noise, radiation, etc.)
- Safety (most common of all hazards like pinch points, frayed cords, trip hazards, etc.)
- Other
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Observation Status
- Urgent
- Needs attention
- Hazard corrected
- Information and identification
- Other
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Observation Description
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Do you have any recommendations that could help correct the hazard.
Observation
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Photos (USE ONLY IF PERMITTED)* Photos are not required
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Photo Description
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Observer Name & Signature
