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Behavior Based Safety Observation Checklist Template

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Behavior Based Safety Observation Checklist Template

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Audit

Was daily safety check completed?

Housekeeping

Aisles/Walkways kept clear?

Work area kept organized?

Housekeeping: spills, cords or other trips, trash/clutter, lighting, or Flammables

Personal Protective Equipment

All appropriate equipment or gear worn correctly?

PPE kept in good condition?

Personal protective equipment: hand, body, eyes/face, head, foot, respiratory, fall protection, hearing protection, or FR clothing/gear

Working Position

Body position

Location in working environment

Working Position: poor posture, over stretched, above shoulder, below knees, twisting, caught in between, struck by, working at heights greater than 4', floor or wall opening, unprotected work edge, or false ceiling or floor.

Tools and Equipment

Appropriate tools or equipment being used?

Tools or equipment being used correctly?

Tools or equipment in good condition?

Tools and equipment: ladders, power or hand tools

Safe behaviors observed-actions taken to encourage safe behavior

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Unsafe behaviors observed-action taken to correct and prevent recurrence

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Line of fire. Is the worker in the line of fire?

Grinding or drilling operations creating flying objects or particles - goggles/face-shield. Heavy equipment movement in the area - operator aware of pedestrian? Around rigging operations - hand in pinch point not under equipment? Working in front of live electrical panel - NFPA70E PPE

Safety procedures

Lock-out/Tag-out, Arc Flash, Hot Work Permit, Confined Space

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