Direct Observation: Fire Boss

Appendix C2: Direct Observation

Fire Boss

Form Approved

OMB No. 0920-xxxx

Expires xx/xx/20xx

Subject ID:

Testing Date:

Recorder:

Task

Equipment

Environment

People

Information

Information Transfer

	Shuttle Car Op
	Roof Bolter
	Utility
	Shift Foreman
	Next CM
	Outside:____________
	Other:______________

People
	Shuttle Car Op
	Roof Bolter
	Utility
	Shift Foreman
	Next CM
	Outside:____________
	Other:______________
Method
	Radio
	Text
	Person:_____________
	Other:______________

	Shuttle Car Op
	Roof Bolter
	Utility
	Shift Foreman
	Next CM
	Outside:____________
	Other:______________

People
	Shuttle Car Op
	Roof Bolter
	Utility
	Shift Foreman
	Next CM
	Outside:____________
	Other:______________
Method
	Radio
	Text
	Person:_____________
	Other:______________

Public reporting burden of this collection of information is estimated to average of 4 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-XXXX).