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Home
Observations
Observations-Field
Observations-Office
Near Miss
FAQ
Observations-Office
Observer Name (not required)
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District
SELECT ONE
NE
NW
KC
CO
CD
STL
SW
SE
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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.
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Housekeeping
Slip/Trip/Fall Hazards
Safe
At-Risk
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Storage/Clutter
Safe
At-Risk
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Comments
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Body Position
Lifting/Bending
Safe
At-Risk
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Reaching/Twisting
Safe
At-Risk
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Paying Attention
Safe
At-Risk
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Comments
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Layout/Work Environment
Monitor Position/Glare
Safe
At-Risk
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Mouse & Pad/Keyboard
Safe
At-Risk
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Adequate Lighting
Safe
At-Risk
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Layout (frequently used tools nearby)
Safe
At-Risk
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Comments
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Noted Safe Behaviors/Actions
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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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