

JOB
OBSERVAT
ION
CHECKLIS
T
SAFE UNSAFE
Environment / Working Conditions
 Housekeeping
 Toxic Atmosphere 
 Work Plans/Procedures JOB
OBSERVAT
Available ION
 Condition of Tools & CHECKLIS
Equipment T
 Hazard Warnings SAFE UNSAFE
 Safety Devices in Place Environment / Working Conditions
Behaviours  Housekeeping
 Using PPE  Toxic Atmosphere
 Procedures Followed  Work Plans/Procedures
 Communicating Available
 Proximity to Other Workers  Condition of Tools &
 Work Pace Equipment
 Horseplay  Hazard Warnings
 Focus on Work / Distraction  Safety Devices in Place
 Balance, Traction, Grip Behaviours
 Pre-Task Planning / Permits  Using PPE
 Recognizing Change  Procedures Followed
Body Mechanics  Communicating
 Reaching / Extending  Proximity to Other Workers
 Lifting / Bending  Work Pace
 Repetitive Motion  Horseplay
 Standing / Sitting  Focus on Work / Distraction
 Comfortable  Balance, Traction, Grip
Line of Fire  Pre-Task Planning / Permits
 Recognizing Change
 Body Position
Body Mechanics
 Energy Sources
 Lock Out  Reaching / Extending
 Guards & Barriers  Lifting / Bending
 Engineering Controls  Repetitive Motion
 Workplace Design /  Standing / Sitting
Condition  Comfortable
 Congested Work Area Line of Fire
Tools & Equipment  Body Position
 Pre-Job Inspection  Energy Sources
 Correct For Task  Lock Out
 Safe Use  Guards & Barriers
Employee Competency Check  Engineering Controls
 Knowledge / Trained /  Workplace Design /
Certificate Condition
 Congested Work Area
 Skill / Experience
Tools & Equipment
Management / Supervisory
 Pre-Job Inspection
 Training / Coaching
 Correct For Task
 Worker / Supervisor
 Safe Use
Competency
Employee Competency Check
 Procedures Available,
Adequate, Understood  Knowledge / Trained /
 Certificate F
 Skill / Experience ol
lo
Management / Supervisory w
 Training / Coaching -
 Worker / Supervisor u
Competency p
 Procedures Available, A
Adequate, Understood ct
io
n
W
h
at
Is
T
o
B
e
D
o
JOB n
OBSERVATI
ON e
CHECKLIST ?
Observer Name (print)

Any change in behaviour during observation

What Was Observed?

Location
Work Observed:
(R/C) Reinforcement / Correction

JOB
OBSERVATI
What Was Said?

ON
CHECKLIST
Observer Name (print)

What Was Observed?

Location
Yes
Date

No
 Work Observed:
What Was Said? Follow-up Action
(R/C) Reinforcement / Correction What Is To Be Done?
A
n

h
a
n
g
e

n
b
e
h
a

o
u

d
u

n
g
o
b

o
n
ri
Yes No
y
c

ti
r

r
i

i
Date