Audit

OPPORTUNITY FOR IMPROVEMENT FIELD FORM

Complete the form and forward it to the Division Safety Manager.

Date:

Name of Originator (type here or use "Sign" function to write below):

Add signature

Division:

The following situation presents an opportunity for improvement:

Impact (check ALL that apply):

My suggestion for a possible solution is:

Supervisor's comments:

Send completed form to Division Safety Manager. Thank you!

Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.