Information
-
Document No.
-
Audit Title
-
Client / Site
-
Conducted on
-
Prepared by
-
Explain in detail any "Safety Concern" or "Near Miss" (include what, when, and where):
-
Photographs of situation observed, damage sustained, etc.
-
Location
-
Your suggestions on how to improve this situation would be greatly appreciated: (Optional)
-
I have corrected the "Safety Concern" / "Near Miss"
-
How has it been corrected?
-
Photographs of corrected items.
-
Date & Time Reported
-
Name of individual reporting
