Title Page

  • Conducted on

  • Prepared by

  • Location
  • Department/Areas Reviewed:

  • Completed by:


Emergency Prepare

  • If No, list corrective actions*

  • Are you trained and current in First Aid/CPR/AED/BBP?

  • If not why?

  • Have your reviewed with team members on what to do in the event of an earthquake, power outage and winter storm event?

  • if not why?

  • Are all Near Miss and first aids reported and given the same importance as incidents involving team member injuries?

  • If not why?

  • Are Team Members aware of the Serious Injury Fatality Prevention (SIF) focus and the rationale for the SIF focus?

  • if not why?

  • Are all incidents reported wtihin 24 hours of knowledge of the event?

  • If not why?

  • Are all spills reported and documented with a spill report form?

  • If not why?

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.