4 Hse Obervation Card

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HSE OBSERVATION

WSI/HSE/FORM-04

□ Safe Act (Safe Behavior)


□ Unsafe Act (At-Risk Behavior)

SAFE & UNSAFE BEHAVIOR OBSERVED:

CORRECTIVE ACTION TAKEN:

RECOMMENDATION:

Observer : ______________________
(Name & Sign)
Date : ______________________
Location : ______________________
SAFETY OBSERVATION CYCLE

SAFE / RISK FILL UP


BEHAVIOR OBSERVATION
FORM

IMMEDIATE STOP AGREE


& IMPROVE

DISCUSS
THE
PROBLEM

Instruction:
1. Observe your workplace everyday by
referring the above cycle.
2. Ensure the corrective action is taken.
3. Complete Observation Report.
4. Send to Site HSE Coordinator for
analysis.

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