Anonymous

Safety Champion Report

The purpose of this report is to identify areas of improvement in safety, as well as highlight safety positives at your job site.

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Use this Template

Title Page

Document No.
Client / Site
Conducted on
Prepared by
Area of Work

Hazard identification

Please add a hazard that you witnessed. You can add as many as you'd like.
Hazard description
Suggested improvements
Please include a picture of the hazard if possible

Near Miss

A near miss is something that could have resulted in an injury but did not. Please add any near misses that you experienced or witnessed today
Description
Suggested improvements
Please include a picture if possible

Positives

Please add any safety positives you witnessed today
Description
Please include a picture if possible

Suggestions

Please add any suggestions you feel would improve the overall safety of this jobsite.
Description
Report Author

Anonymous

Safety Champion Report

The purpose of this report is to identify areas of improvement in safety, as well as highlight safety positives at your job site.

Use this Template

Print as PDF

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.