Ankeny
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| Observer Name | Mike Thornburg |
| Date | 06/19/2024 |
| Location | Ankeny |
| Department | IT |
| Shift | First |
| PPE is adequate and worn correctly | Not Applicable |
| Loading, bending over & twisting | Not Applicable |
| Overstretching, pulling & pushing | Unsafe |
| They are known and respected | Unsafe |
| Floor free of spills and without tripping hazards | Not Applicable |
| Safety guards installed | Not Applicable |
| Interlocks are present, light curtains, emergency stops are working | Unsafe |
| They are in good conditions and they are adequate for the type of job | Unsafe |
| Trapping - pinching points & being hit by an object | Not Applicable |
| Task or work area observed | TEST ONLY |
| Describe the unsafe act or unsafe condition observed as well as the behavior observed, including the immediate countermeasures taken | TEST |