Project Behavioral Observation Form Process Observed Works Package Subcontractor / CName Date _ _ /_ _ /_ _ Time from ______ to ______ Duration Mins _____ Checklist attached ☐ Video ☐ Photo (s) ☐ Observation Summary (Ref checklist for details) Safe ☐ Unsafe Acts ☐ Safe ☐ Unsafe conditions ☐ Status: A. All activities conducted in a safe manner ☐ No negative observations B. Generally conducted in a safe manner ☐ Some aspects of the process require improvement C. Partially conducted in a safe manner ☐ One aspect of a task needs improvement D. Some individual lapses ☐ One person working unsafely part of the time E. Generally conducted in unsafe manner ☐ More than one person working unsafely ATC Engineer-in-charge Supervisor Follow up Action ☐ Analysed by HSE Manager and responsible person _________________ ☐ Reported / shown to team observed ☐ Recommended Action ☐ Follow up recommendation

1. Project
Behavioral Observation
Form
Process Observed
Works Package
Subcontractor / CName
Date _ _ /_ _ /_ _ Time from ______ to ______ Duration Mins _____
Checklist attached ☐ Video ☐ Photo (s) ☐
Observation Summary (Ref checklist for details)
Safe ☐ Unsafe Acts ☐ Safe ☐ Unsafe conditions ☐
Status:
A. All activities conducted in a safe manner ☐ No negative observations
B. Generally conducted in a safe manner ☐ Some aspects of the process require improvement
C. Partially conducted in a safe manner ☐ One aspect of a task needs improvement
D. Some individual lapses ☐ One person working unsafely part of the time
E. Generally conducted in unsafe manner ☐ More than one person working unsafely
ATC Engineer-in-charge Supervisor
Follow up Action
☐ Analysed by HSE Manager and responsible person _________________
☐ Reported / shown to team observed
☐ Recommended Action
☐ Follow up recommendation