Safety Day NW April 19

• Conducted on

  Date

• Prepared by

• Location
  Address

• Process Visited

  Select O&M Emergency ERO Repair Replacement Keyhole Other

  • O&M
  • Emergency
  • ERO
  • Repair
  • Replacement
  • Keyhole
  • Other

• How often do you see the safety information via Cascade? (add additional comments by using the paperclip on the right)

  Monthly

  Every Few Months

  Rarely

  Never

• When was the last time you recorded a hazard on GDFO or via IMS? (add additional comments by using the paperclip on the right)

  Days

  Weeks

  Months

  Never

• What ideas do you have to reduce the number of incidents in NW?

• What do you do to improve safety in your area?

• What does your supervisor/safety representative do to improve safety in your area?

Additional Questions for person completing template (do this once only)

• How are you going to reduce RTCs?

• What will you do to have zero LTIs this year?

• What advice have you given to the team/engineer?