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    Behavior-Based Safety Observation Checklist - SafetyCulture

    Uploaded by

    constantinop.gonzalez
    This document is a behavior-based safety observation checklist from SafetyCulture. It contains sections to record observations about employee ergonomics, use of personal protective equipment, tools and equipment safety, work environment safety, safety procedures, and space for additional observations and the safety manager signature. The checklist can be converted to a digital form for use on smartphones or tablets through a QR code or website link provided.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Behavior-Based Safety Observation Checklist - SafetyCulture

    Uploaded by

    constantinop.gonzalez
    36 views5 pages
    This document is a behavior-based safety observation checklist from SafetyCulture. It contains sections to record observations about employee ergonomics, use of personal protective equipment, tools and equipment safety, work environment safety, safety procedures, and space for additional observations and the safety manager signature. The checklist can be converted to a digital form for use on smartphones or tablets through a QR code or website link provided.

    Original Title

    Behavior-based Safety Observation Checklist - SafetyCulture

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    © © All Rights Reserved

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    This document is a behavior-based safety observation checklist from SafetyCulture. It contains sections to record observations about employee ergonomics, use of personal protective equipment, tools and equipment safety, work environment safety, safety procedures, and space for additional observations and the safety manager signature. The checklist can be converted to a digital form for use on smartphones or tablets through a QR code or website link provided.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    36 views5 pages

    Behavior-Based Safety Observation Checklist - SafetyCulture

    Uploaded by

    constantinop.gonzalez
    This document is a behavior-based safety observation checklist from SafetyCulture. It contains sections to record observations about employee ergonomics, use of personal protective equipment, tools and equipment safety, work environment safety, safety procedures, and space for additional observations and the safety manager signature. The checklist can be converted to a digital form for use on smartphones or tablets through a QR code or website link provided.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 5

    5/3/24, 10:38 Behavior-based Safety Observation Checklist - SafetyCulture

    Go digital today!
    Convert your paper checklists into digital forms
    Scan this QR code to use this paper checklist on your smartphone or
    tablet or visit https://safetyculture.com/

    Information

    Site

    Location 

    Department observed

    Safety Manager

    Conducted on 

    Behavior-based Safety Observation Checklist

    https://public-library.safetyculture.io/products/behavior-based-safety-observation-checklist-YMAin?amp_dev=aa3cb5a6-b7e1-4fe0-a70a-63e3a36… 1/5
    5/3/24, 10:38 Behavior-based Safety Observation Checklist - SafetyCulture

    Ergonomics

    Safe

    Body Lifting
    mechanics Body Adequate Pushing, & lowering Eyes Body None
    posture force pulling, techniques on and/or
    & used reaching path hands
    position & in right
    work position

    At Risk

    Body Lifting
    mechanics Body Adequate Pushing, & lowering Eyes Body None
    posture force pulling, techniques on and/or
    & used reaching path hands
    position & in right
    work position

    Personal Protective Equipment

    Safe

    Hand Fall
    protection protection Eye Respirator, Hearing Usage Condition None
    & dust mask protection
    face

    At Risk

    Hand Fall
    protection protection Eye Respirator, Hearing Usage Condition None
    & dust mask protection
    face

    https://public-library.safetyculture.io/products/behavior-based-safety-observation-checklist-YMAin?amp_dev=aa3cb5a6-b7e1-4fe0-a70a-63e3a36… 2/5
    5/3/24, 10:38 Behavior-based Safety Observation Checklist - SafetyCulture

    Tools & Equipment

    Safe

    Mobile Guards,
    Selection Usage Condition equipment barriers & Motorized None
    warnings equipment

    At Risk

    Selection Usage Condition Mobileequipment Guards, Motorized None


    barriers equipment
    &
    warnings

    Environment & Work Areas

    Safe

    Contact
    Housekeeping Walking Working Walkways, with Contact Contact
    surfaces surfaces fire temperature with with
    equipment rotating sharp
    & equipment edges
    emergency
    access
    routes

    At Risk

    Contact
    Housekeeping Walking Working Walkways, with Contact Contact
    surfaces surfaces fire temperature with with
    equipment rotating sharp
    & equipment edges
    emergency
    access
    routes

    https://public-library.safetyculture.io/products/behavior-based-safety-observation-checklist-YMAin?amp_dev=aa3cb5a6-b7e1-4fe0-a70a-63e3a36… 3/5
    5/3/24, 10:38 Behavior-based Safety Observation Checklist - SafetyCulture

    Procedures

    Safe

    Fall
    protection Chemical LOTO Adherence Awareness Availability Other
    use

    Specify

    Hand Fall
    protection protection Eye Respirator, Hearing Usage Condition None
    & dust mask protection
    face

    At Risk

    Fall
    protection Chemical LOTO Adherence Awareness Availability Other
    use

    Specify

    Hand Fall
    protection protection Eye Respirator, Hearing Usage Condition None
    & dust mask protection
    face

    Sign Off

    Additional Observations

    Safety Manager Name & Signature 

    The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's
    solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice.

    https://public-library.safetyculture.io/products/behavior-based-safety-observation-checklist-YMAin?amp_dev=aa3cb5a6-b7e1-4fe0-a70a-63e3a36… 4/5
    5/3/24, 10:38 Behavior-based Safety Observation Checklist - SafetyCulture
    You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should
    independently determine whether the template is suitable for your circumstances.

    https://public-library.safetyculture.io/products/behavior-based-safety-observation-checklist-YMAin?amp_dev=aa3cb5a6-b7e1-4fe0-a70a-63e3a36… 5/5

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