Information
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Please fill out the report as detailed as you can
Questions or suggestions are always welcome
Email or call Ron at 619-512-6221 ron@yykinc.com
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YYK Maritime
Safety Observation Card System -
Date & Time (remember to change if reporting later) =====>
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Vessel/area
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Observation Type
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Positive
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"At Risk" action
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Unsafe Condition
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Near Miss
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Stop Work Authority Exercised
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Area (further detail /other side)
- Main deck
- Engine room
- Bilge
- Aloft
- Pier
- Dry Dock
- Tank
- Scaffold
- Other shipboard area
- Other outdoor area
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Activity
- Power Tooling
- Blasting
- Painting
- Boom-lift or forklift operation
- Roll Back of Equipment
- Environmental
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If activity was not mentioned in the list, please write here:
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Potential - High (permanent disability/fatality/major spill/serious damage)
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Safety Actions and Observations - choose from relevant options
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Personal Behavior
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Lifting/Pulling/Pushing/Carrying
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Eyes on task
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Safe working position (line of fire)
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Use of PPE (selection and condition)
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Environment (Housekeeping,lighting,stable surface,other jobs in area,etc)
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Equipment (Right for the job,isolation in place,fall harnesses,ladders,etc)
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Procedures (PTW,Risk Assessment, aware of procedure,observing the rules,etc)
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Reason for Behavior
- Did not recognise risk
- Fatigue
- Time Pressue
- Inexperience
- "That's the way we do it"
- Design / Equipment
- Personal Standards
- Vessel/work team expectations
- Not applicable
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Observation Details
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Action Taken / Recommended
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Request Safety Department comments
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Observer Name
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Observer
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Signature. Name or unique ID + sign to the right. =========>
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Push the "export" button, and e-mail the report to ron@yykinc.com
DO NOT push the "Finish" button until you have e-mailed the report.
