Injury Tracking

Date Recordable First Aid Injury Type Body Part Affected Task Performed
Index
Injury Type Body Part Task/Hazard
Bruise Head Mech.Lifting
Cut Ear Manual Lifting
Strain Eye Driving
Burn Neck Walking
Scrape Shoulder Height
Animal Bite Torso Excavation
Insect Bite Arm Hand Tool
Reptile Hand Power Tool
Fracture Wrist Pressure
Puncture Finger Caught Between
Other Back Caught Under
Hip Dropped Object
Leg Powered Equip.
Knee Cleaning
Ankle Stairway
Foot Ladder
Toe Scaffold
Other Cable
Chain
Binder
Knife
Machete
Slip
Fall
Trip
Horseplay
Behavior Observation Tracking

Date Observer Task Observation

Action Taken Condition
 Index of Index of
Behaviors: Known Conditions
PPE Not worn Policy not Established
PPE Wrong Policy not Known/Understood
PPE Condition Policy not Followed
Horseplay Hazard not Recognized
Wrong Tool Hazard Ignored
Damaged Tool Policy not established
Breaking Policy Policy not understood
Bypass Protective Measure Inadequate Training
Inadequate Guard Inadequate Direction
Guard Left Off Inadequate Tools
Driving infraction Inadequate Equipment
Inattention Weather
Direction Ignoring Hazard by Leadership Worksite Layout
Permit Violation Work Permit
Other Other
Positive Recognition
Environmental Impact Index
Date Type Material Cause Type Material Cause
Air Oil Equipment Failure
Spill Land Water Inattention
Spill Water Gas Inadequate Procedure
Spill Stream Glycol Lack of Procedure
Reg.Violation Prod. Water Procedure Not Followed
EMS Waste Procedure not Understood
Other Chemical Bypass Protective Method
Trash Other
Other