Behavior Inspection Report Template
Translated by
ScribdTranslationsBehavior Inspection Report Template
Translated by
ScribdTranslationsLOGO BEHAVIOR INSPECTION
PROJECT: DATE:
PLACE:
BEHAVIOR OBSERVATION
BEHAVIORS DANGEROUS INSURANCE NOT APPLICABLE OBSERVATIONS
Work rhythms are observed without attempts to save time or effort.
Proper use of Personal Protective Equipment, especially
glasses, hearing protectors and respiratory protectors
Hand placement at safe points without risks of entrapment or
hits
Location of personnel out of reach of possible blows from
of personnel with pick or shovel work
Avoid being in front of the danger line, (exposure to sources of energy,
risk of entrapment, crushing, blows, suspended loads
among others).
Eyes on the task
View on the road
Use at least three points of support to ascend / descend.
Proper handling of lifting loads (straight back,
knee flexion and maximum load of 25 Kg
Use of pedestrian paths by workers and use of paths
vehicles by machinery and vehicles
Use of equipment with safety guards
Use of tools in good condition, that are not defective
or you cast a spell
Works with controlled energy sources (isolates / de-energizes)
Use of places for temporary and permanent storage
Use of places for waste disposal
Good treatment among colleagues, cordial phrases and instructions with
respect towards others
Labor relations without violence, mistreatment, or discrimination
Breaks free from cigarette or other substance consumption
psychoactive
Another behavior to highlight is whether it is safe or dangerous: SAFE DANGEROUS NOT APPLICABLE OBSERVATIONS
ACTIONS TO TAKE IN THE OBSERVATION
Could any of the observed practices result in harm to the worker, the environment, or impact the service? If _____ No _____ Only if he/she observed any practice that can
result in imminent accident, stop the operation and indicate the safe way to carry it out. Otherwise, do not inform the workers of anything negative about their behavior, just
Record it and through the HSE personnel, controls for dangerous behaviors will be reinforced.
Realice felicitación al o los trabajadores que hayan tenido comportamientos seguros destacados, a continuación indique su nombres y cargos:
Nombre: Cargo: Nombre: Cargo:
Nombre: Cargo: Nombre: Cargo:
Nombre: Cargo: Nombre: Cargo:
Nombre: Cargo: Nombre: Cargo:
Indicate how the practice and/or behavior could be improved according to what was observed.
INSPECTED BY: REVIEWED BY:
COMPANY: SIGNATURE: