Observations-Office

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.

Housekeeping

Slip/Trip/Fall Hazards

SafeAt-RiskInvalid Input

Storage/Clutter

SafeAt-RiskInvalid Input

Comments

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Body Position

Lifting/Bending

SafeAt-RiskInvalid Input

Reaching/Twisting

SafeAt-RiskInvalid Input

Paying Attention

SafeAt-RiskInvalid Input

Comments

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Layout/Work Environment

Monitor Position/Glare

SafeAt-RiskInvalid Input

Mouse & Pad/Keyboard

SafeAt-RiskInvalid Input

Adequate Lighting

SafeAt-RiskInvalid Input

Layout (frequently used tools nearby)

SafeAt-RiskInvalid Input

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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