Behavioural Based Safety Observation

Submit a behavioural based safety observation.

Doc no:RSAL-IMS-HSSEQ-F-44

Revision date:01.07.2021

Revision no:01

Scoring: Safe = 1 point, At Risk = 0. Mark N/A when a question does not apply — N/A answers are removed from the total so the % reflects only applicable points. Every At Risk answer requires the intervention details and a comment.

Observation details

Observer Name*

Observer email address*

Employee ID Number (person observed)*

RSA Employee Name (person observed)*

Location*

Date of Observation*

Follow-Up Date

Behavioural Based Safety Observations

1. Authorised operations of equipments ▼

Observation	Safe	At Risk	N/A	Photo
Is there a permit required?	Safe	At Risk	N/A	Take Photo From Gallery
Interventions (required when At Risk) Positive reinforcement Yes No Correction & Coaching Yes No Supervisor informed Yes No Further action required (comments)*
Is the permit with the equipment?	Safe	At Risk	N/A	Take Photo From Gallery
Interventions (required when At Risk) Positive reinforcement Yes No Correction & Coaching Yes No Supervisor informed Yes No Further action required (comments)*
Has the employee been trained in the use of the equipment?	Safe	At Risk	N/A	Take Photo From Gallery
Interventions (required when At Risk) Positive reinforcement Yes No Correction & Coaching Yes No Supervisor informed Yes No Further action required (comments)*

2. Proper warning ▼

Observation	Safe	At Risk	N/A	Photo
Signage in place	Safe	At Risk	N/A	Take Photo From Gallery
Interventions (required when At Risk) Positive reinforcement Yes No Correction & Coaching Yes No Supervisor informed Yes No Further action required (comments)*
MHE Horns & beepers are working	Safe	At Risk	N/A	Take Photo From Gallery
Interventions (required when At Risk) Positive reinforcement Yes No Correction & Coaching Yes No Supervisor informed Yes No Further action required (comments)*
Checklist maintained	Safe	At Risk	N/A	Take Photo From Gallery
Interventions (required when At Risk) Positive reinforcement Yes No Correction & Coaching Yes No Supervisor informed Yes No Further action required (comments)*

3. Tools / Equipments ▼

Observation	Safe	At Risk	N/A	Photo
Are in good condition	Safe	At Risk	N/A	Take Photo From Gallery
Interventions (required when At Risk) Positive reinforcement Yes No Correction & Coaching Yes No Supervisor informed Yes No Further action required (comments)*
Suitable for the job	Safe	At Risk	N/A	Take Photo From Gallery
Interventions (required when At Risk) Positive reinforcement Yes No Correction & Coaching Yes No Supervisor informed Yes No Further action required (comments)*

4. Operating at safe speed ▼

Observation	Safe	At Risk	N/A	Photo
Speed limits observed	Safe	At Risk	N/A	Take Photo From Gallery
Interventions (required when At Risk) Positive reinforcement Yes No Correction & Coaching Yes No Supervisor informed Yes No Further action required (comments)*
Turning of MHE's	Safe	At Risk	N/A	Take Photo From Gallery
Interventions (required when At Risk) Positive reinforcement Yes No Correction & Coaching Yes No Supervisor informed Yes No Further action required (comments)*

5. Use of safety devices ▼

Observation	Safe	At Risk	N/A	Photo
Safety guards are in place	Safe	At Risk	N/A	Take Photo From Gallery
Interventions (required when At Risk) Positive reinforcement Yes No Correction & Coaching Yes No Supervisor informed Yes No Further action required (comments)*
Fire extinguishers are charged & are in place	Safe	At Risk	N/A	Take Photo From Gallery
Interventions (required when At Risk) Positive reinforcement Yes No Correction & Coaching Yes No Supervisor informed Yes No Further action required (comments)*
Awareness about spill drill	Safe	At Risk	N/A	Take Photo From Gallery
Interventions (required when At Risk) Positive reinforcement Yes No Correction & Coaching Yes No Supervisor informed Yes No Further action required (comments)*

6. Equipments in safe conditions ▼

Observation	Safe	At Risk	N/A	Photo
Is there a maintained service log	Safe	At Risk	N/A	Take Photo From Gallery
Interventions (required when At Risk) Positive reinforcement Yes No Correction & Coaching Yes No Supervisor informed Yes No Further action required (comments)*
Is there physical damage which could cause the failure	Safe	At Risk	N/A	Take Photo From Gallery
Interventions (required when At Risk) Positive reinforcement Yes No Correction & Coaching Yes No Supervisor informed Yes No Further action required (comments)*

7. Safe use of PPE ▼

Observation	Safe	At Risk	N/A	Photo
Safety shoes / gun boots worn correctly	Safe	At Risk	N/A	Take Photo From Gallery
Interventions (required when At Risk) Positive reinforcement Yes No Correction & Coaching Yes No Supervisor informed Yes No Further action required (comments)*
Helmet worn correctly	Safe	At Risk	N/A	Take Photo From Gallery
Interventions (required when At Risk) Positive reinforcement Yes No Correction & Coaching Yes No Supervisor informed Yes No Further action required (comments)*
Safety glasses / goggles used	Safe	At Risk	N/A	Take Photo From Gallery
Interventions (required when At Risk) Positive reinforcement Yes No Correction & Coaching Yes No Supervisor informed Yes No Further action required (comments)*
Hand gloves used	Safe	At Risk	N/A	Take Photo From Gallery
Interventions (required when At Risk) Positive reinforcement Yes No Correction & Coaching Yes No Supervisor informed Yes No Further action required (comments)*
Safety harness worn correctly (straps, lanyards, anchored etc.)	Safe	At Risk	N/A	Take Photo From Gallery
Interventions (required when At Risk) Positive reinforcement Yes No Correction & Coaching Yes No Supervisor informed Yes No Further action required (comments)*
Face shield used	Safe	At Risk	N/A	Take Photo From Gallery
Interventions (required when At Risk) Positive reinforcement Yes No Correction & Coaching Yes No Supervisor informed Yes No Further action required (comments)*
Respiratory protection used	Safe	At Risk	N/A	Take Photo From Gallery
Interventions (required when At Risk) Positive reinforcement Yes No Correction & Coaching Yes No Supervisor informed Yes No Further action required (comments)*
Chemical resistant apron / suit worn	Safe	At Risk	N/A	Take Photo From Gallery
Interventions (required when At Risk) Positive reinforcement Yes No Correction & Coaching Yes No Supervisor informed Yes No Further action required (comments)*

8. Safe loading / unloading ▼

Observation	Safe	At Risk	N/A	Photo
Is trailer placed on level ground	Safe	At Risk	N/A	Take Photo From Gallery
Interventions (required when At Risk) Positive reinforcement Yes No Correction & Coaching Yes No Supervisor informed Yes No Further action required (comments)*
Wheel chocks are in place	Safe	At Risk	N/A	Take Photo From Gallery
Interventions (required when At Risk) Positive reinforcement Yes No Correction & Coaching Yes No Supervisor informed Yes No Further action required (comments)*
Dock leveler placed properly inside the trailer / container	Safe	At Risk	N/A	Take Photo From Gallery
Interventions (required when At Risk) Positive reinforcement Yes No Correction & Coaching Yes No Supervisor informed Yes No Further action required (comments)*
Vehicle switched off and hand brakes applied	Safe	At Risk	N/A	Take Photo From Gallery
Interventions (required when At Risk) Positive reinforcement Yes No Correction & Coaching Yes No Supervisor informed Yes No Further action required (comments)*

9. Safe lifting ▼

Observation	Safe	At Risk	N/A	Photo
Proper manual lifting	Safe	At Risk	N/A	Take Photo From Gallery
Interventions (required when At Risk) Positive reinforcement Yes No Correction & Coaching Yes No Supervisor informed Yes No Further action required (comments)*
Slings load rating is sufficient	Safe	At Risk	N/A	Take Photo From Gallery
Interventions (required when At Risk) Positive reinforcement Yes No Correction & Coaching Yes No Supervisor informed Yes No Further action required (comments)*
Ground under crane is stable	Safe	At Risk	N/A	Take Photo From Gallery
Interventions (required when At Risk) Positive reinforcement Yes No Correction & Coaching Yes No Supervisor informed Yes No Further action required (comments)*

10. Safe position for task ▼

Observation	Safe	At Risk	N/A	Photo
Body positioned for the task	Safe	At Risk	N/A	Take Photo From Gallery
Interventions (required when At Risk) Positive reinforcement Yes No Correction & Coaching Yes No Supervisor informed Yes No Further action required (comments)*
Proper balance for the task	Safe	At Risk	N/A	Take Photo From Gallery
Interventions (required when At Risk) Positive reinforcement Yes No Correction & Coaching Yes No Supervisor informed Yes No Further action required (comments)*
Safe platform for the task	Safe	At Risk	N/A	Take Photo From Gallery
Interventions (required when At Risk) Positive reinforcement Yes No Correction & Coaching Yes No Supervisor informed Yes No Further action required (comments)*

11. Equipment safely serviced ▼

Observation	Safe	At Risk	N/A	Photo
No visible fluid leaks	Safe	At Risk	N/A	Take Photo From Gallery
Interventions (required when At Risk) Positive reinforcement Yes No Correction & Coaching Yes No Supervisor informed Yes No Further action required (comments)*
Daily checklist is up to date	Safe	At Risk	N/A	Take Photo From Gallery
Interventions (required when At Risk) Positive reinforcement Yes No Correction & Coaching Yes No Supervisor informed Yes No Further action required (comments)*
No physical damage	Safe	At Risk	N/A	Take Photo From Gallery
Interventions (required when At Risk) Positive reinforcement Yes No Correction & Coaching Yes No Supervisor informed Yes No Further action required (comments)*

12. Safe Behaviors (no horseplay) ▼

Observation	Safe	At Risk	N/A	Photo
No MHE tail gate	Safe	At Risk	N/A	Take Photo From Gallery
Interventions (required when At Risk) Positive reinforcement Yes No Correction & Coaching Yes No Supervisor informed Yes No Further action required (comments)*
No horseplay, running, sleeping, fighting etc.	Safe	At Risk	N/A	Take Photo From Gallery
Interventions (required when At Risk) Positive reinforcement Yes No Correction & Coaching Yes No Supervisor informed Yes No Further action required (comments)*
Are you running because of emergency	Safe	At Risk	N/A	Take Photo From Gallery
Interventions (required when At Risk) Positive reinforcement Yes No Correction & Coaching Yes No Supervisor informed Yes No Further action required (comments)*
Do you know and understand the correct work procedure	Safe	At Risk	N/A	Take Photo From Gallery
Interventions (required when At Risk) Positive reinforcement Yes No Correction & Coaching Yes No Supervisor informed Yes No Further action required (comments)*
Awareness about assembly points and emergency plan	Safe	At Risk	N/A	Take Photo From Gallery
Interventions (required when At Risk) Positive reinforcement Yes No Correction & Coaching Yes No Supervisor informed Yes No Further action required (comments)*
Fire fighting training provided and is he/she aware about the same	Safe	At Risk	N/A	Take Photo From Gallery
Interventions (required when At Risk) Positive reinforcement Yes No Correction & Coaching Yes No Supervisor informed Yes No Further action required (comments)*

13. Physically / Mentally fit (no impairment) ▼

Observation	Safe	At Risk	N/A	Photo
Is the person physically competent to safely carry the load, or is an additional person required	Safe	At Risk	N/A	Take Photo From Gallery
Interventions (required when At Risk) Positive reinforcement Yes No Correction & Coaching Yes No Supervisor informed Yes No Further action required (comments)*
Is the employee doing overtime more than 2 hrs a day	Safe	At Risk	N/A	Take Photo From Gallery
Interventions (required when At Risk) Positive reinforcement Yes No Correction & Coaching Yes No Supervisor informed Yes No Further action required (comments)*
No personnel injury / illness which affects the work / task	Safe	At Risk	N/A	Take Photo From Gallery
Interventions (required when At Risk) Positive reinforcement Yes No Correction & Coaching Yes No Supervisor informed Yes No Further action required (comments)*

Score Achieved	0
Possible Score	0

% Score Achieved

0 %

Reward System (Operations)

65-75% - Bronze
76-85% - Silver
86-95% - Gold
96-100% - Platinum

Your level: -

Good observations if any / Comments

Supporting Documents / Photos (optional)

Attachment 1

Take Photo From Gallery

Attachment 2

Take Photo From Gallery

Attachment 3

Take Photo From Gallery

Section 1 of 0 0% answered

0Score

0%%

-Level