immediate / direct CAUSES. Check all that apply.
SUBSTANDARD ACTIONS
1 Operating equipment without authority
2Failure to wam
3. Failure to secure
4 Operating at improper speed
5. Making safety devices inoperable
6. Using defective equipment
7 Failure to use PPE property
8. mproper loading
9 improper placement
10. Improper lifting
11. Improper position fortask
12, Servicกg equipment in operation
13, Horsepay
14. Under the influence of alcohol and/or other drugs
15 Using equipment improperl
16. Failure to follow procedure
BASIC/UNDERLYING CAUSES- Check
PERSONAL FACTORS
1 inadequate physica/physiological capabilty
2. Inadequate mentdpsychdogcal capability
3. Physical or physiological stress
4. Mental or psychological stress )
5Lack of knowledg
6 Lack of skill
7 improper motivation
SYSTEM NEEDS
1. Management leadership and commitment
2. Employee involvement
3 Hazard identification, prevention and Control
4. Occupational Hygiene
5. Safety and Hygieกe Training