Project N° Unit Document Code Serial N° Rev.

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BBS Observation Form

Observers (Surname) Company
Observer Code  Civil /  Mechanical /  Electrical /  Instrument /  Finishing /  PCC /  Other /

Date Survey Time (5-15 minutes) Time of Day: AM PM Night Area visited Survey N

 TCF Works  Site Prepar.  Piling  Civil Works  Fire Proof  Steel Structure  Mechanical  Piping Underg.
 Piping Prefab.  Piping Erection  Electrical  Instrument  Painting  Insulation  Equip. Lifting  Catalyst
 Building  Tanks & Silos  Precomm.  Commissioning  NDT/PWHT  Scaffolding  Transport  Other

WORK CLASS Observed Workers 1 2 3 4 5 6 7 8 9 10 More Subcontractor

AT NOTES POSSIBLE
ITEM BEHAVIOUR SAFE Specific Unsafe Acts Observed /
RISK Improvement Actions Agreed
BARRIERS
1. Adjusting PPE
PEOPLE
2. Changed Work Position
REACTION
3. Rearranging / Stopping Work
4. Head Protection
5. Eyes / Face Protection
6. Foot Protection
7. Hands Protection
PPE
8. Ears Protection
9. Respiratory Protection
10. Working Clothes
11. Other Body Protection
12. Harnesses – Anchor Point
13. Attention / Keeping Eyes on the Job
14. Clear of Pinch Point (Aware of moving parts)
POSITION 15. Stabilized Surface
OF
PEOPLE 16. Out of Line of Fire (unexpected hazards)
17. Walking / Pedestrian
18. Handling and Lifting
19. Ascending / Descending
20. Posture / Repetitive Activity
21. T/E Suitable for the Job
TOOLS /
EQUIPMENT
22. T/E Used Properly
23. T/E In Safe Condition
24. Job Planning / (JHA,PTW, TBM, MSDS)
25. Short Cuts (Procedure / Rule not applied)
JOB 26. Access / Egress
FACTOR 27. Protective Defenses (Barricade, Signs, LOTO)
28. Fire Prevention and Fire Fighting
29. General Site Hazards Awareness
30. Cable, Cord and Hoses
HOUSE 31. Materials Storage / Tool Box
KEEPING – 32. Waste Disposal
ENVIRON
33. Spills Management
MENT
34. Dust
35. Noise
Barriers: Culture, Peer pressure, Complacency - Overconfidence, Disagree to be at risk, Distracted, Environment, Facility equipment condition, Procedure,
Time pressure, Training, Personal Factor

UNSAFE ACTS OBSERVED / IMMEDIATE CORRECTIVE ACTION / FURTHER PREVENTIVE ACTION

Project N° Unit Document Code Serial N° Rev. Pag
e
0000 000 2