Information
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Document No.
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Conducted on
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Name of Person Interviewed
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LOB & District Numbers, City & State Names
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- PBMP
- NEMP
- CMMP
- WCMP
- GCMP
- RMMP
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Location of system check - select from locator icon
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How do you support a culture of Safety that allows employees to participate in the success of the SMS?
- Discuss During Employee Orientation
- Weekly Discussion
- During OSST Meetings
- OJT Coaching
- Formal Documented Process
- Training
- Conduct Data Sampling
- Field Observations
- System Integrity Check
- Performance Review
- Quality Review
- Participation Review
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Additional Information Or Notes for above question:
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How do you promote the observation process?
- Discuss During Employee Orientation
- Weekly Discussion
- During OSST Meetings
- OJT Coaching
- Formal Documented Process
- Training
- Conduct Data Sampling
- Field Observations
- System Integrity Check
- Performance Review
- Quality Review
- Participation Review
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Additional Information Or Notes for above question:
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How do you help prevent reoccurrence of incidents?
- Discuss During Employee Orientation
- Weekly Discussion
- During OSST Meetings
- OJT Coaching
- Formal Documented Process
- Training
- Conduct Data Sampling
- Field Observations
- System Integrity Check
- Performance Review
- Quality Review
- Participation Review
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Additional Information Or Notes for above question:
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How do you ensure new employees and contractors are properly trained to perform the work prior to a task?
- Discuss During Employee Orientation
- Weekly Discussion
- During OSST Meetings
- OJT Coaching
- Formal Documented Process
- Training
- Conduct Data Sampling
- Field Observations
- System Integrity Check
- Performance Review
- Quality Review
- Participation Review
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Additional Information Or Notes for above question:
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How do you promote Safe Driving behaviors within your area of responsibility?
- Discuss During Employee Orientation
- Weekly Discussion
- During OSST Meetings
- OJT Coaching
- Formal Documented Process
- Training
- Conduct Data Sampling
- Field Observations
- System Integrity Check
- Performance Review
- Quality Review
- Participation Review
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Additional Information Or Notes for above question:
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How do you promote DOT Compliance in your area of responsibility?
- Discuss During Employee Orientation
- Weekly Discussion
- During OSST Meetings
- OJT Coaching
- Formal Documented Process
- Training
- Conduct Data Sampling
- Field Observations
- System Integrity Check
- Performance Review
- Quality Review
- Participation Review
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Additional Information Or Notes for above question:
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How do you promote Hazard Identification in your area of responsibility?
- Discuss During Employee Orientation
- Weekly Discussion
- During OSST Meetings
- OJT Coaching
- Formal Documented Process
- Training
- Conduct Data Sampling
- Field Observations
- System Integrity Check
- Performance Review
- Quality Review
- Participation Review
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Additional Information Or Notes for above question:
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How do you promote Safe Working conditions in your area of responsibility?
- Discuss During Employee Orientation
- Weekly Discussion
- During OSST Meetings
- OJT Coaching
- Formal Documented Process
- Training
- Conduct Data Sampling
- Field Observations
- System Integrity Check
- Performance Review
- Quality Review
- Participation Review
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Additional Information Or Notes for above question:
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How do you promote Emergency Preparedness in your area of responsibility?
- Discuss During Employee Orientation
- Weekly Discussion
- During OSST Meetings
- OJT Coaching
- Formal Documented Process
- Training
- Conduct Data Sampling
- Field Observations
- System Integrity Check
- Performance Review
- Quality Review
- Participation Review
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Additional Information Or Notes for above question:
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How do you dedicate time and resources to support the Safety Management System (SMS)?
- Discuss During Employee Orientation
- Weekly Discussion
- During OSST Meetings
- OJT Coaching
- Formal Documented Process
- Training
- Conduct Data Sampling
- Field Observations
- System Integrity Check
- Performance Review
- Quality Review
- Participation Review
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Additional Information Or Notes for above question:
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Agreed Action Items:
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Managers Signature:
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Facilitator Signature:
