Title Page
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Safety Contact Conducted By:
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Safety Contact Conducted On:
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Job Department (Pick from list):
- Mill 1
- Mill 2
- Maintenance
- Shipping
- Warehouse
- Slitter
- Quality
- Office
- Plant wide
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Job Position:
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Who Was Observed?
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What Was Observed?
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Where Was It Observed?
Safety Contact - choose responses from applicable category
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Working Safely
- Proper Use of ALL Required PPE
- Proper Use of Machine/Equipment
- Proper LOTO (Understand & Use)
- Proper Use of Hand Tools
- Proper Body Placement
- Other
- PPE in Good Condition
- Follow & Understand JSA
- Proper Use of Crane
- Proper Use of Mobile Equipment
- Work Area Clean
- Work Area Well Organized
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Unsafe Condition
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Unsafe Act
- Improper Use/Lack of/Damaged PPE
- Improper use of Machine/Equipment
- Improper LOTO
- Improper Manual Movement of Pipe
- Improper Body Placement
- Other unsafe act
- Not Following JSA
Action Taken
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What action was taken during the Safety Contact
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Details of action taken -
Follow-up
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Comments