BBS - Behavioral Based Safety Checklist
General Information
Company Name
Project Title
Working Site
Project Manager
First Name
Last Name
Conducted By
First Name
Last Name
Date
-
Month
-
Day
Year
Date
Time
Hour Minutes
AM
PM
AM/PM Option
1. Ergonomics
Safe
At Risk
N/A
Comments
Body mechanics
Body posture and position
Adequate force used
Pushing, pulling, reaching
Lifting and lowering techniques
Eyes on path and work
Body and/or hands in right position
2. Personal Protective Equipment (PPE)
Safe
At Risk
N/A
Comments
Hand protection
Fall protection
Eye and face
Respirator, dust mask
Hearing protection
Correct and complete PPE
Proper use of PPE
PPE in good condition
3. Tools and Equipment
Safe
At Risk
N/A
Comments
Tools used properly and in good condition
Tools and equipment - correct selection, use
Mobile equipment
Guards, barriers and warnings
Motorized equipment
4. Environment and Work Areas
Safe
At Risk
N/A
Comments
Housekeeping
Walking surfaces
Working surfaces
Area clean and free of obstacles or slip, trip, fall hazards
Walkways, fire equipment, emergency access routes clear of obstructions
Contact with temperature
Contact with rotating equipment
Contact with sharp edges
Caught between, pinch point
Tool slippage
Walking under suspended loads
Confined space
Driver safety
Electrical safety
Harmful substances and environments
Hazardous materials labelled, used and stored properly
5. Procedures
Safe
At Risk
N/A
Comments
Procedures available and up-to-date
Workers aware of procedure
Procedure followed properly
6. Lock Out Tag Out (LOTO)
Safe
At Risk
N/A
Comments
Energy sources identified
Correct use of lock
Correct use of tag
LOTO procedures understood and available
7. Fall Protection
Safe
At Risk
N/A
Comments
Correct fall arrest equipment
Correct use of fall arrest equipment
Fall arrest equipment condition
Fall arrest line correct anchor point
Use of correct ladder, lift or scaffolding
Correct use of ladder, lift or scaffeolding
Correct fall protection barriers
8. Chemical Use
Safe
At Risk
N/A
Comments
Correct Use
Correct storage and labeling
Mixing safely
Correct disposal
Adequate and working ventilation
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