Title Page

  • Conducted on

  • Prepared by

  • Location
  • Name:

  • Date/Time:

  • Location:
  • Contact:


  • Context: Safe People: Capable, competent, aware and engaged. Personnel at all relevant levels understand and perform their responsibilities within the critical process across all phases of the Plan-Do-Check-Act Model. Safe Place: Active hazard management and processes under control. Hazards are identified and risks controlled effectively within the work environment throughout the critical process and across all phases of the Plan-Do-Check-Act Model.

  • What was the topic of conversation?

  • Were the employees able to explain the major risks/hazards associated with the task being undertaken and the necessary controls that were in place? <br>

  • Were the employee confident they could complete the task with the training they had been provided?

  • Did the employees indicate if they had were satisfied with the sites safety performance and how the work they were asked to undertake was planned?

  • Was the equipment/tools provided to the employees well maintained and did they agree it made their job safer?

  • Could the employees tell you about the last serious incident that occurred at either their site or other parts of the business?

  • Additional Comments:

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.