Safety Observation - Delta Services

Date

Time

:

Location

Person Performing Observation

Potential Risk Factor:

Focus on task (Mind and Eyes):

Rushing:

Fatigue/Frustration:

Ergonomic/Lifting:

Cell Phone Usage:

Balance/Traction/Grip:

Proper Work Practices:

Work Place Environment:

SPA Properly Completed:

Proper PPE:

Fall Protection used Properly:

Emergency Preparedness:

If any At Risks were observed why did the employee perform work this way and what can be done to prevent reoccurrence:

Additional comments: