Name* Company Name* Location | Site* What did you observe?* Time* Observation* At RiskSafe Which Activities have you observed: --Choose Category --Manual Handling-MH-Lifting Correctly, Body Position, TILE-MH-Mechanised loads where possibleElectricity-E-Following VVB procedure-E-Isolation forms in placePPE-PPE-Wearing full PPE as per site rules and or require-PPE-PPE clean with sponsor logoWorking at Height-WAH-Fall protection in place-WAH-Working safely at heightJob Factors-JF-Shortcuts/Haste-JF-CommunicationsTools and Equipment-TE-Tool/Equipment Selection, Use, Condition-TE-Tagged and in dateConfined Space-CS-Rescue plan in place with equipment-CS-Top man in placeHousekeeping-H-Rubbish/Debris-H-Material StorageCOVID19-C19-Social distancing not observed-C19-Social distancing observedOther
What caused the behaviour (multiple selection possible):
Time pressureHigh workloadMulti-taskingRepetitiveUnclear directionsDistractionsChange in routineLack of informationUnfamiliar with job taskPersonality conflictsFirst time evolutionHabitLack of communicationInexperienceComplacencyAttitude /mindsetShortcutsForgetfulnessStressFatigueFinancial hardshipDepressionAnxietyBipolarOCDPTSD
