Safety Observation Form
Use to document Safety Concerns. Pictures can be submitted to Safety team.
Date Observed
MM
/
DD
/
YYYY
Describe the safety concern - be specific about location, equipment etc.
Your answer
Action taken (immediate response)
Your answer
Follow up Action needed or taken
Your answer
Team Education
Your answer
Is this situation resolved and just needing monitoring?
Comments, additional details
Your answer
Person reporting/contact person
Your answer
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