Joplin Observation
Observer Name
*
Please Select
John Holmes
Roger Hutcheson
Michael Henady
Doug Engel
Mark Briley
Bill Cash
Gary Checkley
Dave Dugger
Jeremy Essley
Rockey Ewen
Kevin Greenwell
Dean Hawkins
Bob Marret
Jack Russell
Ron Wince
Keith Brown
Retha Thomas
Lesa Branham
Jerry Werner
Joe Bacca
Dennis Burnham
Trevor Devins
Joe Frazier
Curt Black
Jake Youngblood
Paul Ramsey
Teri Roessler
Dustin Mullins
Elliott Ballard
Robert Rhodes
Chris Mandelbaum
Korey Marrett
Date
-
Month
-
Day
Year
Date Picker Icon
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Areas
*
Please Select
0-1000
1-1500
2-2700
3-3000
4-4000
5-5000
6-7000
7-9300
Task being Observed
Group
*
Please Select
Operations
Maintenance
Shipping
Other
# Observed
*
Contractor Name
Please Select
MCA
Joplin Industrial Electric
Logan
Tiff City Pump
Dalton Kilinger
Contractor Name (If not listed above)
Is This a Coached Observation
*
Please Select
Yes
No
1.0 Body Position
1.1 Line of Fire
Safe
At-Risk
1.2 Eyes on Path
Safe
At-Risk
1.3 Eyes on Task/ Hands
Safe
At-Risk
1.4 Ascending / Descending
Safe
At- Risk
1.5 Pinch Points
Safe
At- Risk
2.0 Body Use / Ergonomics
2.1 Lifting / Lowering
Safe
At- Risk
2.2 Twisting
Safe
At- Risk
2.3 Pushing / Pulling
Safe
At- Risk
2.4 Overextended / Cramped
Safe
At- Risk
2.5 Response to Ergo Risks (Repetitive Motion)
Safe
At- Risk
3.0 Tools / Equipment
3.1 Selection / Condition
Safe
At- Risk
3.2 Use
Safe
At- Risk
3.3 Vehicle/ Selection/ Condition/ Use
Safe
At-Risk
3.4 Barricading / Guarding
Safe
At- Risk
4.0 Procedures
4.1 Lockout/ Tagout - Energy Isolation
Safe
At- Risk
4.2 Confined Space Entry
Safe
At-Risk
4.3 Hot Work
Safe
At- Risk
4.4 Permits
Safe
At-Risk
4.5 Communication of Hazards
Safe
At-Risk
4.6 Line Break
Safe
At-Risk
4.9 Arc Flash
Safe
At- Risk
4.10 Hand Brake Set
Safe
At - Risk
4.11 Shuttle Wagon Speed/ Controllable Speed
Safe
At - risk
4.12 Clearance - Crossing
Safe
At - Risk
5.0 PPE
5.1 Head
Safe
At-Risk
5.2 Eyes and Face
Safe
At-Risk
5.3 Hearing
Safe
At-Risk
5.4 Respiratory
Safe
At- Risk
5.5 Hands
Safe
At-Risk
5.6 Body
Safe
At-Risk
5.7 Fall Protection
Safe
At-Risk
5.8 Foot
Safe
At-Risk
5.9 Arc Flash
Safe
At- Risk
6.0 Work Environment
6.1 Walking/ Working Surface
Safe
At-Risk
6.2 Housekeeping/ Storage
Safe
At- Risk
9.0 Other
Safe
At-Risk
Other
15.0 Land
15.1 Appropriate topping off or filling oil in equipment
Safe
At - Risk
15.2 Use container to catch contaminants when bleeding or depressuring pumps or vessels
Safe
At - Risk
15.3 Leaking/ Spilling
Safe
At - Risk
15.4 Does employee stay with mobile equipment when refueling
Safe
At - Risk
15.5 Acid containment checked for leaks
Safe
At - Risk
15.6 Acid lines checked for leaks
Safe
At - Risk
15.7 Mobile equipment checked for leaks
Safe
At - Risk
15.8 Oil storage shed
Safe
At - Risk
15.9 Electrical transformers
Safe
At - Risk
15.10 Recyclables placed in poper container
Safe
At - risk
15.11 Greasy rags/ contaminated material disposed of properly
Safe
At - Risk
15.12 Absorbent material cleaned up properly
Safe
At - Risk
15.13 Over greasing avoided
Safe
At - Risk
15.14 Totes/ containers properly labeled
Safe
At - Risk
15.15 NFPA label affixed to container
Safe
At - Risk
15.16 Paint cans, chemical pails/ containers punctured properly
Safe
At -Risk
16.0 Air
16.1 Removed insulation is properly contained
Safe
At - Risk
16.2 Dust from sandblasting operations is properly contained
Safe
At - Risk
16.3 Dust collection equipment is properly working
Safe
At - Risk
16.4 Are warehouse doors closed when not in use
Safe
At - Risk
16.5 Avoid damage to ACM when working on or near building with transite siding
Safe
At - Risk
17.0 Water
17.1 Absorbing agents used to remove spilled oil before it can get into waterway
Safe
At - Risk
17.2 Water released from bermed area free of contamination/ pH between 6.0 and 9.0
Safe
At - Risk
17.3 Contain spilled urea, DFP and DAP granules before washing area
Safe
At - Risk
17.4 Ensure acid being unloaded does not get in waterway
Safe
At - Risk
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Behavior #
Please Select
1.1
1.2
1.3
1.4
1.5
2.1
2.2
2.3
2.4
2.5
3.1
3.2
3.3
3.4
4.1
4.2
4.3
4.4
4.5
4.6
4.9
4.10
4.11
4.12
5.1
5.2
5.3
5.4
5.5
5.6
5.7
5.8
5.9
6.1
6.2
15.1
15.2
15.3
15.4
15.5
15.6
15.7
15.8
15.9
15.10
15.11
15.12
15.13
15.14
15.15
15.16
16.1
16.2
16.3
16.4
16.5
17.1
17.2
17.3
17.4
9.0
While (Task)
Yes
No
Was (At-Risk)
Yes
No
Because (Barrier)
Yes
No
Suggestion
Yes
No
Intent
Yes
No
Aware of Risk
Yes
No
Agree with Risk
Yes
No
Behavior Type
Enabled
Difficult
Non- Enabled
Follow- Up Needed
Yes
No
Employee Comments
Work Order Written
Yes
No
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Additional Employee Observation/ Comments
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