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JOB OBSERVATION
Personal Information
Items with
*
are required
First Name
Last Name
Employer
Activity
Site Name
Activity
What Was Observed?
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Was feedback offered?
Yes
No
Was recognition provided?
Yes
No
What was communicated? (Required when recognition provided)
Observation Detail
Please Select Applicable Description from One of the Categories Below:
Hazard Awareness
Positive
Choose:
Correcting An Unsafe Act
Analyzing Task Hazards
Using Signage or Barriers
Recruiting Spotters
At Risk
Choose:
Unsafe Act
Missed Hazards
Inadequate Signage or Barriers
Spotter spotter not used
Working Environment
Positive
Choose:
Resolving Safety Issues
Housekeeping Conditions
Improving Work Conditions
Guards and Barriers
Workplace Design
At Risk
Choose:
Resolving Safety Issues
Housekeeping Conditions
Work Conditions
Guards and Barriers Inadquate
Poor Workplace Design
Job Planning and Processes
Positive
Choose:
Preplanning
Managing Scope Changes
Communicating Hazards
Taking Time
Demonstrating Knowledge
Suggesting Improvements
Requesting Equipment
At Risk
Choose:
Preplanning
Managing Scope Changes
Communicating Hazards
Taking Time
Demonstrating Knowledge
Suggesting Improvements
Requesting Equipment
Communication
Positive
Choose:
Participating in Planning
Communicating H&S Issues
Encouraging Others to Report
Responding to Feedback
Job Safety Analysis
Communication Methods
At Risk
Choose:
Participating in Planning
Communicating H&S Issues
Encouraging Others to Report
Responding to Feedback
Job Safety Analysis
Communication Methods
Personal Protection
Positive
Choose:
Use of PPE
Making PPE Available
Maintaining PPE
Dressing For The Weather
Asking for Help Lifting
Requesting Training
At Risk
Choose:
Use of PPE
Making PPE Available
Maintaining PPE
Dressing For The Weather
Asking for Help Lifting
Requesting Training
Equipment/Tools
Positive
Choose:
Using Equipment
Maintaining Equipment
Selecting Equipment
Storing Equipment
At Risk
Choose:
Using Equipment
Maintaining Equipment
Selecting Equipment
Storing Equipment
Body Position
Positive
Choose:
Line of Fire
Using Balance, Traction and Grip
Overreaching
Overexerting
Stretching and Microbreaks
Using Barriers
Asking for Help Lifting
At Risk
Choose:
Line of Fire
Using Balance, Traction and Grip
Overreaching
Overexerting
Stretching and Microbreaks
Using Barriers
Asking for Help Lifting
Leadership/Supervision
Positive
Choose:
Coaching
Promoting Team Work
Engaging in Safety Meetings
Asking for Worker Input
Inviting Expert Opinion
Modeling Good Behavior
Training
Other
Other (Required when Other Checked)
At Risk
Choose:
Coaching
Promoting Team Work
Engaging in Safety Meetings
Asking for Worker Input
Inviting Expert Opinion
Modeling Good Behavior
No Training Provided
Other
Other (Required when Other Checked)
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Job Obs
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