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)

  • Include All Employees Present.

  • 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

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.