Behavioral Safety Observation
Stop, Think, Observe, Proceed
Name
First Name
Last Name
Date
-
Month
-
Day
Year
Date
Work Location
Task Being Observed
What sort of behavior was observed?
Safe Practices
Unsafe Practices
Near Miss Incident
Stop Work Authority
Observation Type
House Keeping
Pinch Points
Fall Hazard
Equipment
Material Handling
PPE
Chemicals
Tools
Enviromental
Other
Who were the involved individuals?
Eagle Employees Only
Client Employees Only
Both
Describe your observation
Was the situation corrected immediately?
YES
NO
Not Applicable
What are the suggested adjustments?
Submit
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