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Behavior-based Safety Checklist

A behavior-based safety checklist is a direct observation tool used to recognize safe behavior and eliminate the root cause of unsafe acts. Use this checklist to easily observe critical safe behavior such as the right selection of tools for the job, proper lifting techniques, and more. This checklist includes potential root causes for unsafe acts to help organizations implement the correct improvement measures.
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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
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Please note that this checklist template is a hypothetical appuses-hero example and provides only standard information. The template does not aim to replace, among other things, workplace, health and safety advice, medical advice, diagnosis or treatment, or any other applicable law. You should seek your professional advice to determine whether the use of such a checklist is appropriate in your workplace or jurisdiction.
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