Safety Observations Report Δ Safety Observations Quick Guide Category Details & Examples Report on a Close Call/Near Miss An incident could have happened but did not. While operating a forklift I nearly struck the wall while backing out. A tool fell from height and nearly struck my foot while I was working on machine. While walking through warehouse I witnessed a pipe fall over in the walkway where employees were walking. Make Us Better At risk behaviors Slings in the warehouses need taken out of service due to frays. Positive Behaviors Field hand constantly abides by all safety procedures and ensures others follow suit. Substandard Conditions The roof leaks in the corner when strong winds and rain occur. Suggestions We should paint walkways in shops green with yellow borders to give a better visual of walkways. Tip: Content will wrap on phones; scroll if needed. Date MM slash DD slash YYYY Category(Required)Select a category …HousekeepingEquipmentPPEBehaviorNear MissProcessOtherSelect the general type of safety issue observed.Area/Department(Required)Select a location …3401-A3401-A Warehouse3401-B3401-C3401 Maintenance300130033005-A3005-B3005-C3005 Maintenance20002100230019001901 North Assembly1901 Warehouse1901 South AssemblyAlbany YardHemlock YardOffice AreaField Service (Fleet)Choose the company department or operational area related to the observation.Observation Type(Required)Select a type …Positive BehaviorSubstandard ConditionClose Call/Near MissSuggestion/At-Risk BehaviorChoose the option that best represents your observationSeverityLowMediumHighRate the seriousness of the observation: Low (minimal risk), Medium (moderate risk), or High (immediate or serious risk).Has the hazard been corrected? Yes No Corrective Actions Taken/NeededDescribe any corrective actions that have been taken to address the observed safety issue, or outline the actions that are still needed. Include details such as responsible parties, timelines, and any follow-up steps required.Description(Required)Provide a detailed explanation of the observation, including what was seen, when, and any contributing factors. Upload Photo – Limit 1 (Optional) Drop files here or Select files Accepted file types: jpg, jpeg, png, gif, Max. file size: 50 MB, Max. files: 1. Attach one or more photos that show the observed condition, hazard, or near miss. Clear images can help the Safety Department better understand and address the issue. Only upload images you are authorized to share, and avoid including identifiable individuals unless necessary for safety purposes.Name(Required) First Last Optional. Include your name if you are willing to be contacted for clarification or follow-up.Email(Required)
