Information
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Document No.
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Observation Title
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Project, Job Site, or Job Number
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Conducted on
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Observation Performed by
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Location (Address or Map Coordinate)
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Employee(s) Present
Observation
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Employee Observed
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Crew Observed
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Observation Classification
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Observation Category
- Communication
- PPE
- Housekeeping
- Material Handling
- Fire Protection
- Welding & Burning
- Tool Use
- Electrical
- Fall Protection
- Ladders & Scaffold
- Confined Space
- Excavation
- Lockout/Tagout
- Floating Equipment
- Dive Operations
- Personnel Qualifications
- Procedures
- Emergency Preparedness
- Human Performance
- Site Conditions
- Environmental Conditions
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Observation Description
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Observation Status
- Urgent
- Action
- Follow-up
- Completed
- Lesson Learned
- Near Miss
- Information Only
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Action Taken
Observation Reporting
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Risk Rating
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Photo
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Photo Description
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Site Contact Type
- UESI Employee
- UESI Supervisor
- Customer
- Contractor
- Other
- N/A
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Site Contact Name
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Observer Name & Signature
