Observation-Field

Observer Name (not required)
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District
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Date

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Observed-Dept. or Org
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Task/Job Observed
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Location of Observation
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Please skip the item or section if it is not applicable to the task/job that is included in the observation. A skipped question is considered NA.
 
PPE
Hi-Visibility Clothing
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Eyes/Face
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Hardhat
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Hand (gloves adequate)
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Footwear
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Hearing Protection
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Respiratory
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Fall Protection
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Comments
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Body Position
Lifting/Pushing/Pulling
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Awkward/Twisting/Bending
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Paying Attention
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Pinch Point
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3 Points of Contact
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Struck by Potential
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Pace
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Comments
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Tools & Equipment
Correct Tool/Equipment
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Used Correctly
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Condition of Tool/Equipment
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Comments
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Housekeeping
Slip/Trip/Fall Hazards
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Clear Floor/Exits
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Lighting
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Comments
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Vehicular Operations
Walk Around/Circle Check
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Seatbelt
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Stability & Terrain (rollover hazard)
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Attachments
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Overhead Hazards
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Backing/Spotting
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Vehicle Visibility/Parking Location
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Comments
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Noted Safe Behaviors
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Reasons Behind At-Risk Behaviors
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Solutions Proposed/Implemented
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Attach a photo or video. (not required)
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