BBS/STEP Form



Date
Client
Name
Locaton
Job Activity
Explanation of Activity
Comments, Feedback, Action Taken
Was this safety check...

Personal Protective Equipment:
Head:    Safe
   At Risk
Eyes:    Safe
   At Risk
Ears:    Safe
   At Risk
Hands:    Safe
   At Risk
Feet:    Safe
   At Risk
Respiratory:    Safe
   At Risk
Harness/Lanyard:    Safe
   At Risk
Work Vest:    Safe
   At Risk

Slips, Trips, and Falls
Stairs:    Safe
   At Risk
Ladders:    Safe
   At Risk
Walkways:    Safe
   At Risk
Housekeeping:    Safe
   At Risk
Open Holes:    Safe
   Unsafe
Rig Floor:    Safe
   At Risk

Material Handling:
Mannual Lift:    Safe
   At Risk
Body Position:    Safe
   At Risk
Tag Lines:    Safe
   At Risk
Mechanical Lift:    Safe
   At Risk
Crane Operation:    Safe
   At Risk
Communication:    Safe
   At Risk

Tools and Equipment:
Proper Tools:    Safe
   At Risk
Inspection:    Safe
   At Risk
Condition:    Safe
   At Risk
Secured:    Safe
   At Risk
Proper Use:    Safe
   At Risk
Guards:    Safe
   At Risk
Lockout/Tagout:    Safe
   At Risk

Personal Transfer:
Vessel:    Safe
   At Risk
Swing Rope:    Safe
   At Risk
Auto:    Safe
   At Risk
Personal Basket:    Safe
   At Risk
Air Craft:    Safe
   At Risk

Environmental:
MSDS:    Safe
   At Risk
Storage:    Safe
   At Risk
Housekeeping:    Safe
   At Risk
Labeling:    Safe
   At Risk
Disposal:    Safe
   At Risk

Always remember you have the responsibility to use Stop Work Authority, if necessary.
Did you give positive feedback during your observation?    Yes
   No
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