FER Observation Form

Observation Form

Project:

Location:

Date:

Time:

Name:

OBSERVATION TYPE

BBS Observation (Behavior-Based Safety) Positive Unsafe Act/Condition Environment

SAFETY OBSERVATION CRITICAL FACTORS

(S = SAFE, C = CONCERN) — Only check boxes that apply to observation

PPE / Procedure / Methods

S C

Body Position

S C

Slips / Trip / Falls

S C

Equipment / Work Environment

S C

STOP WORK USED? Yes No

DESCRIBE OBSERVATION

DESCRIBE ACTION TAKEN / FEEDBACK GIVEN

OBSERVER'S SIGNATURE

Observer Name:

Signature (draw below):

Date: