Title Page

  • Observer's Name:

  • Date and Time:

  • Observer's Department:

  • Area Visited:

  • Additional Team Members Present:

  • Job Description

  • Positive Behaviours Observed:

  • Opportunities for Improvement:

  • 1. What are the risks in your area that can kill you?

  • 2. What critical controls are in place to protect you?

  • 3. How do you know these critical controls are effective?

  • Add photo as required:

  • Signed by Lead Observer:

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.