Power 420 pamphlet

Safety Observation

Keeping Safety a Priority
Protecting Our Workers by Eliminating Risk
DATE*

MonthDayYear
Date
Hour MinutesAM/PM Option
LOCATION*
OBSERVER (optional)
TYPE OF ACTIVITY:*
YESNO
OPERATORMECHANIC
Observation coaching and feedback will be done in confidential and non-threatening way.
CRITICAL BEHAVIOR

VEHICLE OPERATION

Rows	SAFE	AT RISK	N/A
Pre-Trip Inspection
Speeding
Weather/Road Conditions
Backing
Seat Belt/Emergency Brake

PERSONAL PROTECTION EQUIPMENT

Rows	SAFE	AT RISK	N/A
Hearing Protection
Body/Fall Protection
Back
Hand/Arms
Foot Protection
Knees
Respiratory Protection
Eye/Face Protection
Hearing Protection

CRITICAL ERROR REDUCTION

Rows	SAFE	AT RISK	N/A
Line of Fire
Eyes on Task
Mind on Task
Balance/Traction /Grip
Human Performance Tool Use

TOOLS AND EQUIPMENT

Rows	SAFE	AT RISK	N/A
Safe Selection
Safe Condition
Safe Use

PROCEDURE / WORK PRACTICES

Rows	SAFE	AT RISK	N/A
Communication: Customer/Contractor/Other
Pre-Job Briefing
Capacities/Ratings
Securing Loads
Work Lighting
Energy Control/Tagout
Crew Communication

PROCEDURE / WORK PRACTICES

Rows	SAFE	AT RISK	N/A
Following Established Work: Method/Procedure
Minimum Approach Distance
Confined Space/Manhole Entry
Excavation
Guarding/Barricades
Electrical Switching

ENVIRONMENTAL

Rows	SAFE	AT RISK	N/A
Walking/Working Surfaces
Weather Conditions
Housekeeping/First Aid Kit
Dogs/Poisonous Plants/Insects

BODY MECHANICS/ ERGONOMICS

Rows	SAFE	AT RISK	N/A
Lifting/Bending/Twisting
Reaching/Pulling/Lifting
Static Position
Stretching

Positive Feedback Given:
Possible Best Practice:
Concerns:
Recommendations:
Should be Empty: