Page 16 - Crane and Rigging

Environmental, Safety & Health
Safety Leadership Workshop

[Project Name]
Behavior Observation Checklist

Observer: ____________________________ Date: ________________________________

Number Observed: 1 2 3 4 Time of Day: AM_____ PM_____Night______
Craft: _______________________________ Work Location/Area: ___________________

Subcontractor: ________________________
Categories Safe At-Risk Observations (include exactly what
you saw and employee’s response)
1.0 Body Mechanics
1.1 Lifting ______ ______ ___________________________
1.2 Body Position ______ ______ ___________________________
1.3 Pinch Points ______ ______ ___________________________
1.4 Line of Fire ______ ______ ___________________________
1.5 Eyes on Work/Path ______ ______ ___________________________
1.6 Ascending/Descending ______ ______ ___________________________
2.0 Personal Protective Equipment
2.1 Eye/Face Protection ______ ______ ___________________________
2.2 Head Protection ______ ______ ___________________________
2.3 Hand Protection ______ ______ ___________________________
2.4 Fall Protection ______ ______ ___________________________
2.5 Hearing Protection ______ ______ ___________________________
2.6 Respiratory Protection ______ ______ ___________________________
2.7 Body Protection ______ ______ ___________________________
3.0 Job Factors
3.1 Shortcuts/Haste ______ ______ ___________________________
3.2 Communications ______ ______ ___________________________
3.3 Work Surfaces ______ ______ ___________________________
3.4 Barricading ______ ______ ___________________________
4.0 Tools and Equipment
4.1 Tool/Equipment Selection ______ ______ ___________________________
4.2 Tool/Equipment Use ______ ______ ___________________________
4.3 Tool/Equipment Condition ______ ______ ___________________________
4.4 Ladders ______ ______ ___________________________
4.5 Vehicle Operations ______ ______ ___________________________
5.0 Housekeeping
5.1 Trash/Debris ______ ______ ___________________________
5.2 Material Storage ______ ______ ___________________________
5.3 Hoses, Cords and Leads ______ ______ ___________________________
5.4 Proper Control of Haz. Materials ______ ______ ___________________________
6.0 Other

Rev 2, US 09/04

Suggestions:
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