Title Page
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Observer
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Work Location
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Date & Time
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Day of the Week
- Sunday
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
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Weather Conditions
- Sunny
- Cloudy
- Dark/Night
- Rain
- Recently Rained
- Fog
- Currently Snowing
- Snow on the Ground
- Icey
- Windy
Body Mechanics
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(17% of injuries)
- When lifting / lowering bend at the knees, maintain proper back posture, keep load close to body without twisting at the waist
- Get assistance for large or awkward loads
- Maintain center of balance, do not overextend or over reach -
Safe / Concern
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Reason for Concern / How They Are Safe
Pre-Task Plan (W.H.A.T. Book)
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(14% of injuries)
- Complete W.H.A.T. book before task
- Pre-task inspection and warnings about potential risks
- Barricades and signs around hazards
- Task coordination among workers and shifts -
Safe / Concern
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Reason for Concern / How They Are Safe
Tool Selection and Use
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(17% of injuries)
- Select the proper tool for the job (use punch or chisel instead of screwdriver)
- Use appropriate size ladders for access areas -
Safe / Concern
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Reason for Concern / How They Are Safe
Line of Fire/ Pinch Points / Eyes on Path
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(41% of injuries)
- Keep eyes and direction of travel and task
- Look behind when backing
- Maintain focus on surroundings, body position, and equipment when performing a task -
Safe / Concern
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Reason for Concern / How They Are Safe
General Comments
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Comments:
