STOP Form

Mark if any Unsafe	Mark if all Safe	Mark if any Unsafe	Mark if all Safe
Reactions of People Adjusting Personal Protective Equipment Changing Position Rearranging Job Stopping Job Attaching Grounds Performing Lockouts Positions of People Injury Causes Striking Against or Being Struck by Objects Caught In, On, or Between Objects Falling Contacting Temperature Extremes Contacting Electric Current Inhaling, Absorbing or Swallowing a Hazardous Substance Repetitive Motions Awkward Positions / Static Postures		Personal Protective Equipment Head-to-Toe Check Head Eyes and Face Ears Respiratpry system Arms and Hands Trunk Legs Tools and Equipment Right for the Job Used Correctly In Safe Condition Procedures Available Adequate Known Understood Followed Orderliness Standards Known Understood Followed
Complete the Observation Report Conditions Tools and Equipment Environment Structures and Work Area Orderliness Safe Acts Observed Actions Taken to Encourage Continued Safe Performance Unsafe Acts Observed Immediate Corrective Actions Action to Prevent Recurrence
Name Area		Shift Date

Complete the Observation Report