Walls Indonesia SBO Form

1. Observer Name *

2. Staff identification number *

Without 000

Enter Company Name if you are a contractor

3. Date and Time

4. Area *

Ammonia
Non-ammonia

5. Type of work being observed

Type:

Description:

6. Object/Name of person being observed *

7. Number of personnel

8. Response [RP]

Wearing personal protection
Change position of existing installation, workplace, or work behavior
Creating new work plan
Stopping the work
De-energizing power sources
Installing safety equipment

9. Personal Protective Equipment [PPE]

Head protection
Breathing
Face protection
Safety belt
Safety shoes
Eye protection
Hand protection
Ear/hearing protection
Body protection

10. Tools and Equipment [TE]

Damaged tools
Improper tools

11. Work Procedure and 5S [PO]

Not following the correct procedure
Lack of knowledge in correct procedure
Inadequate 5S standard
Unavailable procedure

12. Person's Position [PP]

Falling
Electric shock
Contacting extreme temperature
Inhaling extreme temperature
Contacting dangerous chemical materials
Lifting object beyond capability
Unproper work position
Crash by object
Trapped inside of, on top of, or between the object

13. Safe action/condition being observed

Safe ACT Safe CONDITION

14. Unsafe action/condition being observed

Unsafe ACT Unsafe CONDITION

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