ISNetworld® Certification Fast | Behavior Based Safety Observation Checklist

We are going to make completing your Behavior based safety observation checklist form as easy as possible.

Complete the form down below. Then scroll to the bottom and click 'Submit'. That's it!

Company Name:

Date observation:

Observer name:

Behavior based safety observation is a proactive, data-driven approach focusing on observing and modifying unsafe behaviors before they cause incidents. Unlike traditional compliance (which audits conditions), BBS targets human actions through: Peer-to-peer observations, Positive reinforcement, Root-cause analysis of behavioral choices.

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a. Observe anonymously for 5-15 minutes b. Record safe/unsafe behaviors c. Note antecedents (time pressure, poor lighting, etc.)

If you select 'other', please elaborate in the description of incident box

Observation Location:

Observation type:

self

other

Positive recognition:

yes

Behavioral state:

Critical Errors:

eyes not on task

mind not on task

balance/grip

line of fire

other

Safety at risk

No risk/not applicable

Complete the section below if any of the following are a risk: PPE, line of fire, ergonomics or equipment/tools. If none of these are a risk, check the box above.

Equipment/tools:

unsafe condition

inappropriate for task

capacity exceeded

Line of fire:

body position - risk of being struck/caught

guards/rails/safety devices - missing or inoperable

energy isolation needed

Ergonomics:

lifting/bending/twisting

reaching/extending/pulling

repetitive motion

needs additional assistance

PPE needed:

Description of incident:

Corrective action (if applicable):

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Team Member Email

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Client Email