Title Page
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Company Name
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Location
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Company Representative (name and title)
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Conducted on
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Prepared by (name and title)
Introduction
Copyright
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All rights reserved. No part of this document may be reproduced or transmitted in any form by any means, electronic or mechanical, including photocopying and recording, or by an information storage or retrieval system, except as may be permitted, in writing, by Acquainted Talent .
Confidentiality Statement
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In order to maintain the integrity and credibility of the risk analysis processes and to protect the parties involved, it is understood that Acquainted Talent and its representatives will not divulge to unauthorised persons any information obtained during this Safety Observation unless legally obliged to do so.
Observations & Assessments
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Do you have any concerns about your health and safety in relation to your current assignment?
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Has your role or the location of your work changed in any way from the original scope of your assignment?
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Should the assignment continue?
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Provide Detailed Information as to why the placement should not continue
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COMPLETED BY:
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Position:
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Signature:
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Date:
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Additional Notes:
