| Observer Name | Tyler Kinnie |
|---|---|
| Date | 10/07/2026 |
| Location | Ankeny |
| Department | |
| Shift | Third |
| Before Picture | |
| PERSONAL PROTECTIVE EQUIPMENT | |
| PPE is adequate and worn correctly | Safe |
| ERGONOMICS | |
| Loading, bending over & twisting | Not Applicable |
| Overstretching, pulling & pushing | Not Applicable |
| SAFETY PROCEDURES | |
| They are known and respected | Unsafe |
| FLOOR, AISLES & WORK AREAS | |
| Floor free of spills and without tripping hazards | Unsafe |
| SAFETY IN MACHINERY | |
| Safety guards installed | Unsafe |
| Interlocks are present, light curtains, emergency stops are working | Unsafe |
| POWERTOOLS AND HANDTOOLS | |
| They are in good conditions and they are adequate for the type of job | Unsafe |
| AT THE FIRE LINE | |
| Trapping - pinching points & being hit by an object | Unsafe |
| OTHER QUESTIONS | |
| Task or work area observed | B15 back door |
| Describe the unsafe act or unsafe condition observed as well as the behavior observed, including the immediate countermeasures taken | The back glass is out and sitting on the floor for some reason. |
| If a follow up is required, describe the actions to be taken | Tell someone that you messed up and it needs to be fixed |
