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Safety Behavior Observation Checklist: Observe Quietly. Mark Each Observation Item

The document provides a safety behavior observation checklist and report for field project management personnel to complete weekly to evaluate safety compliance. The checklist contains 5 sections to score employees on proper use of PPE, safe work positions, adherence to rules and procedures, safe tool and equipment use, and housekeeping with a total possible score of 100. The report is used to document any immediately dangerous safety issues observed, corrective actions taken, and an overall safety score.

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khrayzie bhone
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2K views1 page

Safety Behavior Observation Checklist: Observe Quietly. Mark Each Observation Item

The document provides a safety behavior observation checklist and report for field project management personnel to complete weekly to evaluate safety compliance. The checklist contains 5 sections to score employees on proper use of PPE, safe work positions, adherence to rules and procedures, safe tool and equipment use, and housekeeping with a total possible score of 100. The report is used to document any immediately dangerous safety issues observed, corrective actions taken, and an overall safety score.

Uploaded by

khrayzie bhone
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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SAFETY BEHAVIOR OBSERVATION

CHECKLIST
“All Field Project Management Personnel shall complete this form weekly, as minimum, and retain in the project records”.

Observe quietly. Mark each observation item.


N/A If Not Applicable
0 If Non-Compliant
1 If Needs Improvement
2 If Compliant

1. Personnel Protective Equipment (PPE) 3. Rules and Procedures


“ Are all employees wearing and properly using approved PPE in SCORE REMARKS
good condition for: Procedures Developed
SCORE REMARKS Procedures known and
Head Understood
Ears Supervisor at Work
Face Activity Personnel
Respiratory Protection Certified/Competent
Hands Work Activity Personnel
Body Approved Safety Officer
Feet on Site
TOTAL SCORE 1 – TOTAL SCORE 3 –

2. Position of People 4. Tools and Equipment


“Do all employees maintain safe positions to prevent: SCORE REMARKS
SCORE REMARKS Correct for the job
Falls Used Properly
Overexertion Safe condition
Striking Against/ Struck By TOTAL SCORE 4 –
Caught Between Objects
Intake/Contacts with 5. Housekeeping
Hazardous Substance SCORE REMARKS
Contact with Hot/Cold Good Housekeeping
Surface Dust Control
Contact With Electric Material Stacking
Current De-nailing
TOTAL SCORE 2 – TOTAL SCORE 5 –

TOTAL SCORE

SAFETY BEHAVIOR OBSERVATION


REPORT
SBOR#:
Contractor Safety Observation Report
Contractor Company: Contract / BI Number:
Work Location Area: Observation Date:
Contractor Area Supervisor: Contractor Area Supervisor’s Company ID / Badge #:
Were any observation consideration immediately dangerous to
Immediately Corrective Action(s) Taken:
Life or Health (IDLH) Yes No (If yes, describe
Verbal Written Stop Work
below)
Describe Key Observation: Record Corrective Action Taken Requested:

Observer Name: Title:


Observer Signature: Badge #: Organization Code:

LEGEND:
99-100 Excellent
95-98 Very Good Score = (Sum of all Scores / Target Score) X 100
85-94 Good
78-84 Satisfactory Total Score = Sum of all Scores / No. of Scores
75-77 Poor

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