Title Page

  • Conducted on

  • Prepared by

  • Employee ID

  • Ramp

  • Elevation

  • Shift


  • Task/Job

  • Required Permits

  • Potential Risks

  • Mitigation/Corrections

  • Do I need to exercise my Stop Unsafe Work Authority?

  • Sign if you agree with this statement: I take personal responsibility for my safety and the safety of my co-workers.

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.