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
2 digit month, 2 digit day, 4 digit year
Date
Time
Hour Minutes
AM
PM
AM/PM Option
1. Ergonomics
Rows
Safe
At Risk
N/A
Comments
Body mechanics
1
2
3
Body posture and position
4
5
6
Adequate force used
7
8
9
Pushing, pulling, reaching
10
11
12
Lifting and lowering techniques
13
14
15
Eyes on path and work
16
17
18
Body and/or hands in right position
19
20
21
2. Personal Protective Equipment (PPE)
Rows
Safe
At Risk
N/A
Comments
Hand protection
22
23
24
Fall protection
25
26
27
Eye and face
28
29
30
Respirator, dust mask
31
32
33
Hearing protection
34
35
36
Correct and complete PPE
37
38
39
Proper use of PPE
40
41
42
PPE in good condition
43
44
45
3. Tools and Equipment
Rows
Safe
At Risk
N/A
Comments
Tools used properly and in good condition
46
47
48
Tools and equipment - correct selection, use
49
50
51
Mobile equipment
52
53
54
Guards, barriers and warnings
55
56
57
Motorized equipment
58
59
60
4. Environment and Work Areas
Rows
Safe
At Risk
N/A
Comments
Housekeeping
61
62
63
Walking surfaces
64
65
66
Working surfaces
67
68
69
Area clean and free of obstacles or slip, trip, fall hazards
70
71
72
Walkways, fire equipment, emergency access routes clear of obstructions
73
74
75
Contact with temperature
76
77
78
Contact with rotating equipment
79
80
81
Contact with sharp edges
82
83
84
Caught between, pinch point
85
86
87
Tool slippage
88
89
90
Walking under suspended loads
91
92
93
Confined space
94
95
96
Driver safety
97
98
99
Electrical safety
100
101
102
Harmful substances and environments
103
104
105
Hazardous materials labelled, used and stored properly
106
107
108
5. Procedures
Rows
Safe
At Risk
N/A
Comments
Procedures available and up-to-date
109
110
111
Workers aware of procedure
112
113
114
Procedure followed properly
115
116
117
6. Lock Out Tag Out (LOTO)
Rows
Safe
At Risk
N/A
Comments
Energy sources identified
118
119
120
Correct use of lock
121
122
123
Correct use of tag
124
125
126
LOTO procedures understood and available
127
128
129
7. Fall Protection
Rows
Safe
At Risk
N/A
Comments
Correct fall arrest equipment
130
131
132
Correct use of fall arrest equipment
133
134
135
Fall arrest equipment condition
136
137
138
Fall arrest line correct anchor point
139
140
141
Use of correct ladder, lift or scaffolding
142
143
144
Correct use of ladder, lift or scaffeolding
145
146
147
Correct fall protection barriers
148
149
150
8. Chemical Use
Rows
Safe
At Risk
N/A
Comments
Correct Use
151
152
153
Correct storage and labeling
154
155
156
Mixing safely
157
158
159
Correct disposal
160
161
162
Adequate and working ventilation
163
164
165
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