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Behavior Based Employee Observation

Division*
Location*
Location*
Location*
Area*
Inspector's Initials*
House Keeping
Slip Trip Hazards*
- Safe
- At Risk
Orderly Storage*
- Safe
- At Risk
Clear Aisles*
- Safe
- At Risk
Housekeeping Comments
PPE
Head*
- Safe
- At Risk
Eyes*
- Safe
- At Risk
Face*
- Safe
- At Risk
Hearing*
- Safe
- At Risk
Hand*
- Safe
- At Risk
Knee*
- Safe
- At Risk
Foot*
- Safe
- At Risk
Body*
- Safe
- At Risk
PPE Comments
Tools
Correct Tool for Task*
- Safe
- At Risk
Proper Use of Tool*
- Safe
- At Risk
Tool in Good Condition*
- Safe
- At Risk
Trained in Tool Use*
- Safe
- At Risk
Tools Comments
Equipment
Correct Equipment. for Task*
- Safe
- At Risk
Proper Use of Equipment*
- Safe
- At Risk
Equipment in Good Condition*
- Safe
- At Risk
Trained in Equipment Use*
- Safe
- At Risk
Equipment Inspected*
- Safe
- At Risk
Equipment Comments
Body Position
Lifting / Bending*
- Safe
- At Risk
Reaching / Twisting*
- Safe
- At Risk
Pushing / Pulling*
- Safe
- At Risk
Walking / Climbing*
- Safe
- At Risk
Crawling / Squatting*
- Safe
- At Risk
Neutral, Stable Posture*
- Safe
- At Risk
Pinch Points (employee understands danger of pinch points and observes safe work practices)*
- Safe
- At Risk
Body Position Comments
Company Policy
Lockout Tagout During Service or Maintenance*
- Safe
- At Risk
Confined Space Entry*
- Safe
- At Risk
Fall Protection*
- Safe
- At Risk
Company Policy Comments
Pace of Work
Fast*
- Safe
- At Risk
Normal*
- Safe
- At Risk
Fast*
- Safe
- At Risk
Pace of Work Comments
Pass or At Risk*
- Pass
- At Risk
If any of the above criteria have been marked as "At Risk", please mark this as failed.
Observer Input
Recommendation or Action Taken
Observer Feedback
Phone
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Employee
Resources

800.658.7049

Behavior Based Employee Observation

House Keeping

PPE

Tools

Equipment

Body Position

Company Policy

Pace of Work