Behaviour-based safety observation form for recording safe and at-risk behaviours and worker conversations
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| # | Observation Item | Detail | Safe | At-Risk | Notes |
|---|---|---|---|---|---|
| Observation Details | |||||
| 1 | Date and time of observation | ||||
| 2 | Location and work area | ||||
| 3 | Task or activity observed | ||||
| 4 | Duration of observation | ||||
| 5 | Worker or crew observed | ||||
| 6 | Environmental conditions (weather, lighting, noise) | ||||
| Safe Behaviours Observed | |||||
| 7 | Correct PPE worn and fitted | ||||
| 8 | Correct tools and equipment used | ||||
| 9 | Proper body positioning and manual handling | ||||
| 10 | Housekeeping and work area organisation | ||||
| 11 | Communication between workers | ||||
| 12 | Compliance with procedures and permits | ||||
| At-Risk Behaviours Observed | |||||
| 13 | PPE not worn or incorrectly fitted | ||||
| 14 | Shortcuts or steps skipped | ||||
| 15 | Incorrect body positioning or manual handling | ||||
| 16 | Poor housekeeping or work area congestion | ||||
| 17 | Lack of communication or situational awareness | ||||
| 18 | Non-compliance with procedures or permits | ||||
| Worker Conversation | |||||
| 19 | Safe behaviours acknowledged with worker | ||||
| 20 | At-risk behaviours discussed with worker | ||||
| 21 | Worker perspective and feedback recorded | ||||
| 22 | Barriers to safe behaviour identified | ||||
| 23 | Agreed actions documented | ||||
| Actions and Follow-Up | |||||
| 24 | Action 1 description and responsible person | ||||
| 25 | Action 2 description and responsible person | ||||
| 26 | Action 3 description and responsible person | ||||
| 27 | Due dates assigned for all actions | ||||
| 28 | Observation report submitted | ||||
| 29 | Follow-up review date set | ||||
I confirm that all items have been inspected/completed as indicated above. Any defects or concerns have been noted and reported.