Title Page
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Prepared by
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Location
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NAME (OPTIONAL)
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DEPARTMENT
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FUNCTION
- PU DSP
- PU SHF
- PU USP
- MS&T LAB ANALYTICS
- MS&T LAB DSP
- MS&T LAB USP
- QC LAB BIOASSAY
- QC LAB IPC
- QC LAB MICROBIOLOGY
- QC LAB RAW MATERIALS
- QC LAB DRUG SUBSTANCE RELEASE
- SE
- OTHERS
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AREA OBSERVED
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IMAGE OF UNSAFE WORK ENVIRONMENT/UNSAFE ACT
POSITIVE SAFETY OBSERVATION
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DESCRIPTION
UNSAFE OBSERVATION/OPPORTUNITY FOR IMPROVEMENT
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DESCRIPTION
CORRECTIVE/PREVENTIVE ACTIONS
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WHAT DID YOU DO TO FIX THE UNSAFE WORK ENVIRONMENT?
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WHAT IS REQUIRED TO FIX THE UNSAFE WORK ENVIRONMENT?
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HOW CAN THE UNSAFE WORK ENVIRONMENT BE PREVENTED IN THE FUTURE?
