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BEHAVIOR BASED RISKS OBSERVATION FORM

In our goal of fostering a safe and healthy workplace, your participation in identifying
Behavior-Based Risks is very important. On a weekly basis, your department should convene
for a brief meeting to determine and evaluate risks and recommend sensible measures to
prevent untoward events that may happen due to the following circumstances:
Unsafe Act

Unsafe Practice

Unsafe Condition
_____________________

Unsafe Environment

Others:

Observation:

Observers Recommendation:

Observers Name:

Area:

Period Covered:

Area Response:

Fill-out this section after the Monthly Management Meeting

Management Decision and Action:

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