BOS Fall Safety Summit Form

• FIRST NAME/LAST NAME/Fall Safety Summit

• Client Name / Rig Name

• Conducted on

  Date
• Location
  Address

Engage, Care, Listen and Act

• Engage with the employee or contractor with a caring conversation. Listen to their concerns, needs, and recommendation to have a safety and efficient operation. Reassure them them action will be taken to continuously improve our performance both operationally and safety with a shared vision of Zero Harm and commitment to Stop Work Authority.

• Behavior(s) or condition(s) identified for improvement

• Expected sustainable improvement

• Photo of the Site

  Media

Signatures

• Add Management

Management

• Name of Management

  Sign

• Add Employees

Employee or Contractor

• Name of Employee

  Sign