Chris Haefele

MCDGRPNZ See Say Do

You Report We Improve

Use this Template

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Use this Template

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Information

Work Activity?
Location of work?
Reported by?
Reported to?
Conducted on

SEE SAY DO (YOU REPORT - WE IMPROVE)

REPORT CLASSIFICATION?
- A BETTER WAY
- IMPROVEMENT
- UNSAFE CONDITION
- UNSAFE BEHAVIOUR
WHO?
WHAT DID YOU OBSERVE (REPORT)?
POSSIBLE CONSEQUENCES?
YOUR SUGGESTED ACTION?

OFFICE USE ONLY

NEAR MISS
HAZARD
OFI
NCR
ISSUE OWNER (DIRECT)
ISSUE OWNER (INDIRECT)
GOLDEN RULE BREACH (YES / NO)
AGREED ACTION 1:
ACTION ASSIGNED TO?
ACTION DUE DATE?
AGREED ACTION 2:
ACTION ASSIGNED TO?
ACTION DUE DATE?
DATE ENTERED TO DATA BASE?
DATABASE ENTRY BY?

Chris Haefele

MCDGRPNZ See Say Do

You Report We Improve

Use this Template

Print as PDF

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.