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Safety Observation Form
Please input all fields marked with *
Safe Observation - Praise
Unsafe Observation - Coach
STOP AND SPOT
Observer’s Name :
Nombre del observador :
Date:
Fecha:
Time:
Hora:
Job :
Trabajo :
Specific Location:
Ubicación Específica :
Supervisor/Manager:
Supervisor/Gerente:
OBSERVATIONS
Behavioral
Rushing
Eyes not on task
Frustration
Mind not on task
Fatigue
Line-of-fire
Complacency
Balance/Traction/Grip
Unsafe action
Equipment/Tools
Unsafe condition
Inappropriate for task
Capacity exceeded
Ergonomics
Lifting, bending, twisting
Reach, extending, push/pull
Repetitive motion
Needs additional assistance
Line-Of-Fire
Body position, risk of being struck/caught-in
Guards, railings, safety devices
PPE Needed
Head
Hand
Respiratory
Eyes/face
Body
Hearing
Foot
Fall arrest
Notes:
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