Title Page
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Observer's Name:
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Date and Time:
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Observer's Department:
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Area Visited:
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Additional Team Members Present:
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Job Description
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Positive Behaviours Observed:
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Opportunities for Improvement:
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1. What are the risks in your area that can kill you?
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2. What critical controls are in place to protect you?
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3. How do you know these critical controls are effective?
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Add photo as required:
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Signed by Lead Observer:
