Name of Supervisor
What type of event was witnessed?
Select
Hazard
Unsafe Work Practice
Hazard Unsafe Work Practice
Add media
Media
what was the corrective action?
Select
Documented Employee Coaching
PIT Post-Event Documentation
Driver Redirect
Near Miss Report
On-the-Spot Correction
Facility Work Order
Other
Documented Employee Coaching PIT Post-Event Documentation Driver Redirect Near Miss Report On-the-Spot Correction Facility Work Order Other
What type of event was witnessed?
Select
Hazard
Unsafe Work Practice
Hazard Unsafe Work Practice
Add media
Media
what was the corrective action?
Select
Documented Employee Coaching
PIT Post-Event Documentation
Driver Redirect
Near Miss Report
On-the-Spot Correction
Facility Work Order
Other
Documented Employee Coaching PIT Post-Event Documentation Driver Redirect Near Miss Report On-the-Spot Correction Facility Work Order Other
What type of event was witnessed?
Select
Hazard
Unsafe Work Practice
Hazard Unsafe Work Practice
Add media
Media
what was the corrective action?
Select
Documented Employee Coaching
PIT Post-Event Documentation
Driver Redirect
Near Miss Report
On-the-Spot Correction
Facility Work Order
Other
Documented Employee Coaching PIT Post-Event Documentation Driver Redirect Near Miss Report On-the-Spot Correction Facility Work Order Other
What type of event was witnessed?
Select
Hazard
Unsafe Work Practice
Hazard Unsafe Work Practice
Add media
Media
what was the corrective action?
Select
Documented Employee Coaching
PIT Post-Event Documentation
Driver Redirect
Near Miss Report
On-the-Spot Correction
Facility Work Order
Other
Documented Employee Coaching PIT Post-Event Documentation Driver Redirect Near Miss Report On-the-Spot Correction Facility Work Order Other
What type of event was witnessed?
Select
Hazard
Unsafe Work Practice
Hazard Unsafe Work Practice
Add media
Media
what was the corrective action?
Select
Documented Employee Coaching
PIT Post-Event Documentation
Driver Redirect
Near Miss Report
On-the-Spot Correction
Facility Work Order
Other
Documented Employee Coaching PIT Post-Event Documentation Driver Redirect Near Miss Report On-the-Spot Correction Facility Work Order Other
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Anonymous
My Five - Hazards or Unsafe Work Practice Identified and Corrected
Each supervisor has the goal of identifying and correcting up to five hazards or unsafe work practices per week.
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.