ADB/Mercury Good Catch Form

• Conducted on

  Date

• Prepared by

• Location
  Address

Good Catch Reporting and Positive Observation

• Company Name

• Team Memeber Name

• Supervisor

• Job

• Date

• Location

Observation Description

• Good Catch or Positive Observation

  Unsafe Act

  Unsafe Condition

  Positive Observation

• Briefly describe the observation

• Photo of Condition

  Media

Corrective Action/Suggestion

• Were you able to correct the problem:

  Yes

  No

  N/A

• What corrective actions were taken?

• Suprvisor/Manager action?

• Risk Severity

Signoff

• Name and signature of inspector

  Sign