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BBS - Behavioral Based Safety Checklist Form Template

Enhance Workplace Safety with Our BBS Checklist Template

You need a reliable way to ensure your team's safety while promoting positive behaviors at work. This BBS checklist template is designed for safety managers and HR professionals who want to implement an effective behavioral-based safety program. With this template, you can easily track observations, encourage employee involvement, and identify safety trends, leading to a more proactive safety culture. Effortlessly promote accountability and enhance safety protocols as you use this WCAG-aligned template to tailor your program to your needs.

Observer full name
Observation date
Location or site
Area or department
Task or activity observed
Workgroup of persons observed
Employee
Contractor
Visitor
Mixed
Unknown
Permission obtained to observe and provide feedback
Yes
No
Not applicable
PPE required for this task (select all that apply)
Please Specify:
Required PPE worn correctly
Yes
No
Not applicable
Unable to determine
Body positioning and line of fire
Safe
At risk
Not observed
Not applicable
Lifting and ergonomics
Safe
At risk
Not observed
Not applicable
Use of tools and equipment
Safe
At risk
Not observed
Not applicable
Machine guarding and pinch points
Safe
At risk
Not observed
Not applicable
Housekeeping and walkways
Safe
At risk
Not observed
Not applicable
Working at heights and fall protection
Safe
At risk
Not observed
Not applicable
Energy isolation and lockout or tagout
Safe
At risk
Not observed
Not applicable
Chemical handling and labeling
Safe
At risk
Not observed
Not applicable
Driving, vehicles, or mobile equipment
Safe
At risk
Not observed
Not applicable
Communication and hand signals
Safe
At risk
Not observed
Not applicable
Any at-risk behaviors or conditions observed
Yes
No
Not sure
Describe at-risk behaviors or conditions
Immediate corrective action taken
Yes
No
Not applicable
Describe corrective action or feedback provided
Contributing factors (select all that apply)
Please Specify:
Suggestions to prevent recurrence
Positive safe behaviors observed
Recognition or praise provided
Yes
No
Not applicable
Overall safety performance observed
Poor
Fair
Good
Very good
Excellent
Responsible person or team for follow-up
Follow-up due date
Follow-up required
Yes
No
Not sure
Observer signature (printed name)
Signature date
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Paper art illustration depicting a checklist form related to behavioral based safety for FormCreatorAI article

When to use this form

Use this checklist when you want to observe real work and coach safe habits in the moment. It fits field crews, shop floors, labs, and warehouses. Run it during pre-job walkthroughs, while monitoring hot work, or when reviewing lifting, line-of-fire, and housekeeping. Supervisors, safety reps, and peer observers benefit by capturing what people do, not just what is on a plan. The outcome: quick feedback, clear notes, and trend data you can share in toolbox talks. Pair it with the Job safety analysis form to confirm task hazards, the PPE Assessment form to verify the right gear is used, and the Fire risk assessment form when heat, sparks, or flammable materials are present.

Must Ask BBS - Behavioral Based Safety Checklist Questions

  1. What task is being performed and where is the observation taking place?

    Knowing the task and location sets context and helps you compare behaviors across similar jobs and sites. It also supports trend reports and targeted coaching for high-risk areas.

  2. Which safe behaviors did you observe and want to recognize?

    Recognition reinforces what you want repeated and builds trust with crews. Documenting specifics (e.g., proper spotting or three-point contact) turns praise into clear standards.

  3. Which at-risk behaviors did you observe, and what could go wrong if they continue?

    Stating the potential consequence makes the risk real and helps prioritize actions. It improves your ability to remove the hazard or redesign the step, not just blame the worker.

  4. What immediate coaching or corrective action did you take on site?

    Recording what you did closes the loop and proves the observation led to action. It also gives others a repeatable fix they can apply on the next job.

  5. Are required permits, tools, and PPE suitable and available for this task?

    This check prevents work from starting without the basics, which is a common root cause of incidents. For hot work or cutting, confirm authorization using the Hot work permit form.

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