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Behavior based safety checklist template

Behavior based safety checklist template

Promote a safer workplace with this behavior-based safety checklist. It helps identify and reinforce safe behaviors while addressing potential risks. Use this checklist to enhance safety culture and reduce workplace incidents.

Use this template
or download pdf
Behavior based safety checklist template

Promote a safer workplace with this behavior-based safety checklist. It helps identify and reinforce safe behaviors while addressing potential risks. Use this checklist to enhance safety culture and reduce workplace incidents.

Use this template
or download pdf

About the Behavior based safety checklist template

Ensuring a safe workplace environment involves more than just equipment checks; it requires attention to employee behavior and practices. A behavior based safety checklist is designed to help you systematically observe and document safe and unsafe behaviors in the workplace. 

This checklist allows you to identify patterns, reinforce positive actions, and address areas needing improvement. Whether you’re a safety manager in manufacturing or construction, using this checklist helps you streamline safety audits, foster a culture of safety, and improve overall operational efficiency.

Key elements of a behavior based safety checklist

Understanding the key elements of a behavior based safety checklist is essential for enhancing workplace safety and efficiency. Here are the crucial components you should include:

  • Observation criteria: This section outlines specific behaviors to monitor, such as proper use of personal protective equipment (PPE) or adherence to safety protocols. By clearly defining what to observe, you can ensure consistency and focus during safety audits, capturing relevant data for analysis.
  • Behavior categorization: Categorize behaviors into safe and unsafe actions. This helps you quickly identify areas needing improvement and reinforces positive behaviors. It also allows you to track trends over time, enabling proactive measures to enhance safety culture.
  • Feedback and action plan: Include a section for providing feedback to employees and developing action plans for improvement. Constructive feedback encourages safe practices and helps address unsafe behaviors effectively, fostering a culture of continuous improvement.
  • Documentation and reporting: Ensure that all observations and actions are documented thoroughly. This provides a clear record for future reference, supports accountability, and facilitates communication with stakeholders about safety performance and initiatives.

By incorporating these elements into your behavior based safety checklist, you can create a comprehensive tool that enhances safety, ensures compliance, and optimizes your workplace operations.

Best practices for using a behavior based safety checklist

To maximize the effectiveness of your behavior based safety checklist, follow these best practices. Ensure clear and specific observation criteria by defining exactly what behaviors you are monitoring. This helps maintain consistency across audits and ensures that you capture relevant data.

Regularly update the checklist to reflect changes in safety protocols or work environments, keeping it relevant and comprehensive. Encourage open communication by providing constructive feedback to employees and involving them in developing action plans for improvement. This fosters a culture of safety and accountability.

Train your team on the importance of using the checklist consistently and accurately. Regular training sessions can reinforce best practices and address any challenges your team might face. Finally, review completed checklists periodically to identify patterns or recurring issues, allowing you to address them proactively and enhance overall safety and compliance.

Related categories

  • Health and safety management templates
  • General templates
  • Workplace safety templates
Preview of the template
Behavior-based Safety Checklist
Safety Observation Steps: 1. Introduce yourself, put the worker at ease, and explain the process. Ask permission to do an observation. 2. Ask the person to explain the job that is being performed and define the hazards and precautions associated with the task/s they are performing. 3. Ask open-ended questions to learn more about at-risk barriers. (Ex: What’s the worst accident that can happen? How could you be hurt doing this task?)
[This is an example of how you can use Lumiform to include best practice reference images in your templates to assist with observations]
4. Observe the job and add comments by tapping NOTE/photos by tapping IMAGE. Provide positive feedback by praising safe behaviors first. Draw out the corrective action that may be required (create this action by tapping ACTION). 5. Obtain a commitment that the individual will carry out this action and thank the person for participating.
CRITICAL SAFE BEHAVIOR
PPE
Head Protection - (hard hat worn appropriately where the hazard exists)
At-Risk Barrier
Eye & Face Protection (proper eye and face protection for the task - glasses, face shield, goggles)
At-Risk Barrier
Hearing Protection (proper hearing protection where the hazard exists - ear plugs, ear muffs)
At-Risk Barrier
Hand Protection (proper gloves)
At-Risk Barrier
Body Protection (proper protective clothing, long pants, shirt with at least 4" collar)
At-Risk Barrier
Visibility - Class II (minimum) hi-visibility safety vest
At-Risk Barrier
Foot Protection (proper foot protection - steel-toed shoes or boots)
At-Risk Barrier
BODY USAGE & POSITION
The worker is positioning his body to avoid injury by any moving hazards (caught between, falling objects)
At-Risk Barrier
Lifting (proper lifting techniques - using legs, back straight, weight close to the body, feet flat on the ground, knees bent)
At-Risk Barrier
Pinch Point (aware of and avoid pinch points - pinch points blocked, maintaining body parts out of pinch points)
At-Risk Barrier
Awkward Position (proper body mechanics - over-extended, using leg not back when pulling)
At-Risk Barrier
TOOLS & EQUIPMENT
Tool Use/Selection (using the right tool for the job and using it properly - correct style wrench, pry bar)
At-Risk Barrier
Condition - tools, even if correct for the job, must be in good condition (air hoses, hose connections, pipe wrench, etc)
At-Risk Barrier
Position Parked (the vehicle is left in the position which creates the least possibility of an incident and safety of the public)
At-Risk Barrier
EYES ON PATH/HANDS
Eyes On Path (watching where you're going and go where you're watching - looking for/being aware of hazards).
At-Risk Barrier
Eyes On Hands (aware of hand placement - watching where hands are placed during work or near hazard, not being distracted)
At-Risk Barrier
Ascending/Descending (proper climbing techniques on trucks and trailers - facing the ladder, not skipping rungs or steps, hold onto handles)
At-Risk Barrier
Travel Path (non-hazardous route of travel, a path of the least potential incident - walking/driving around spills, barricades, rough terrain)
At-Risk Barrier
Travel Speed (rate of speed to minimize potential incidents based on environment, surroundings or changing conditions)
At-Risk Barrier
COMPLETION
Additional Observations
Observer Name & Signature
This template was downloaded 2 times

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Frequently asked questions

How does a behavior based safety checklist improve workplace safety?

A behavior based safety checklist improves workplace safety by systematically identifying and addressing unsafe behaviors. It helps reinforce positive actions and provides data-driven insights to develop targeted interventions, fostering a proactive safety culture that reduces accidents and enhances overall safety performance.

What should I do if I observe unsafe behavior during an inspection?

If you observe unsafe behavior, address it immediately by providing constructive feedback and discussing the potential risks. Collaborate with the individual to create an action plan for improvement, ensuring they understand the importance of adhering to safety protocols and fostering a culture of continuous improvement.

Why is employee involvement important in behavior based safety programs?

Employee involvement is crucial because it encourages ownership and accountability for safety practices. Engaging employees in safety programs increases their awareness, motivates them to follow protocols, and enhances communication, leading to a more effective and sustainable safety culture.

How can I ensure my team consistently uses the behavior based safety checklist?

To ensure consistent use, provide comprehensive training on the checklist and its importance. Encourage open communication and feedback to address any challenges, and regularly review the checklist process to reinforce best practices and maintain high safety standards.


This template, developed by Lumiform employees, serves as a starting point for businesses using the Lumiform platform and is intended as a hypothetical example only. It does not replace professional advice. Companies should consult qualified professionals to assess the suitability and legality of using this template in their specific workplace or jurisdiction. Lumiform is not liable for any errors or omissions in this template or for any actions taken based on its content.
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