Title Page

  • Date of Submission

  • Submitted by

  • Choose which publication you would like to make a change to.

  • Date of Publication

  • Revision Number or Latest Change Date

  • Is your change due to an emergency or safety related incident?

  • If your change is due to an emergency or safety related issue, did you fill out a HIRS form?

  • Page Number

  • Major / Sub Paragraph Title or Chart / Figure Number

  • Text or figure as presently reads (list what is considered to be incorrect or missing)

  • Change to Read (Describe the desired changes)

  • Rationale (Provide reason or additional comments for this recommendation)

  • Submitted by

  • Reviewed by

  • Reviewer with approval/disapproval authority:

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.