Title Page

  • Document No.

  • AREA OBSERVADA:

  • SITE:

  • FECHA Y HORA DE LA OBSERVACION:

  • OBSERVACION LEVANTADA POR:

  • UBICACION FISICA (GPS)
  • EQUIPO DE PERSONAS PARTICIPANTES:

  • EVENTOS DEL REPORTE

  • EVENTO #:
  • TIPO DE OBSERVACION

  • Descripción del evento observado:

  • Oportunidad de Mejora, Acto o condición insegura o sub-estándar.

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