UGL STARR

• Conducted on

  Date

STARR Information

• Project/Site

• Task Observed

• Observed on

  Date

• No. of People Observed

Checklist

• Actions of people

  Safe

  At Risk

• At risk actions

  Select Adjusting PPE Changing Position Rearranging Job Stopping Job

  • Adjusting PPE
  • Changing Position
  • Rearranging Job
  • Stopping Job

• Appropriate PPE

  Safe

  At Risk

• At risk PPE

  Select Head Eyes Ears Respiratory System Arms & Hands Trunk Legs & Feet

  • Head
  • Eyes
  • Ears
  • Respiratory System
  • Arms & Hands
  • Trunk
  • Legs & Feet

• Equipment Use

  Safe

  At Risk

• At risk equipment use

  Select Wrong for the job Used incorrectly In an unsafe condition

  • Wrong for the job
  • Used incorrectly
  • In an unsafe condition

• Body Position and Use

  Safe

  At Risk

• At risk body positioning

  Select Struck by object Striking against object Caught in, on or under objects Overexertion Awkward/static positions Falling/tripping Contacting electrical current Contacting temperature extremes Inhaling hazardous substances Swallowing hazardous substances Absorbing hazardous substances Repetitive motion

  • Struck by object
  • Striking against object
  • Caught in, on or under objects
  • Overexertion
  • Awkward/static positions
  • Falling/tripping
  • Contacting electrical current
  • Contacting temperature extremes
  • Inhaling hazardous substances
  • Swallowing hazardous substances
  • Absorbing hazardous substances
  • Repetitive motion

• Adherence to Procedures

  Safe

  At Risk

• At risk procedure

  Select Procedure or SWMS inadequate Procedure or SWMS not followed Procedure or SWMS unknown or misunderstood Housekeeping standards inadequate Housekeeping standards unknown or misunderstood Poor facility/working condition UTake5 not conducted

  • Procedure or SWMS inadequate
  • Procedure or SWMS not followed
  • Procedure or SWMS unknown or misunderstood
  • Housekeeping standards inadequate
  • Housekeeping standards unknown or misunderstood
  • Poor facility/working condition
  • UTake5 not conducted

Observations

• Safe acts observed

• Unsafe acts observed

Sign off

• Signature

  Sign