Observation Card
Job Observation / Task Analysis
Date/Time: ___________________ Supervisor Name: __________________________________________
Observer Name ___________________ Facility Name: __________________________________________
Person on Job: ___________________ Department: __________________________________________
Job Title: ___________________ Area/Location: __________________________________________
Identify Potential Hazards
Chemical Burn Electric Shock Inhalation Hazard Thermal Burn Loud Noise
Fire Pinch Point Overexertion Cave-In Particles in Eye
Elevated Work Heat Stress Inadequate Guards Overhead Work Slips, Trips and Falls
Spills Abrasions Laceration Falling Hazards Sprains and Strains
Rotating Equipment Inadequate Lighting _________________ _________________ ________________
Identify Hazard Elimination/Correction
Rubber Gloves/Face Shield/Rain Suit Face Shield/Mono Toe Boards/Netting Erect Barricades
Personal Protective Equipment Fire Hose/Extinguisher Hearing Protection Use Respirator
Scaffolds/Safety Harness/Fall Protection Proper Sloping/Shoring Contain Sparks Proper Tools
Electrical Gloves/Flash Suit Proper Body Leather Gloves Get Help
Spill Containment Supplies Improve Housekeeping Temporary Lighting ________________
Deficiencies
Recommendations
Reviewed by (Name/Title)
