Title Page
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Site conducted
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Conducted on
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Prepared by
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Examples of a SOSA include, but are not limited to: Factory Condition changes (water on the floor, trip hazards), Machinery Condition (frayed wires, oil leaks), or Safety Action taken by an employee outside of normal activity or job description (machine operator notices another operator using improper lifting techniques).
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Location of SOSA observation
Observation Information
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Shift observer is working
- A
- B
- C
- D
- 1st
- 2nd
- 3rd
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Description of SOSA Observation
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Is there a safety risk?
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At Huhtamaki - Goodyear we employ the 4D method to categorize SOSA Observations. They are: DIRTY - Does it need to be cleaned or have preventative maintenance completed?; DANGEROUS - is it a hazardous condition?; DIFFICULT - does it create a safety concern?; DIFFERENT - is it how the work is normally completed?
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Which of the 4D categories does the SOSA fall into:
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Has the SOSA been corrected?
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Did you speak to a team member in the area about the SOSA?
SOSA Reporter and Supervisor Signatures of Validation
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SOSA Observer
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Shift supervisor. By signing this form I acknowledge the items of this form and I commit to report and correct if its in my abilities any or all items listed here
