Title Page

Safety engagement details

  • Use this form to record safety engagements as per SMS-10-GD-3146 Safety Engagements.

    Custodian: Safety Specialist
    Issue Date: 25/11/14
    Approved by: Group Manager Safety
    Doc No. SMS-10-FM-4356

  • Directorate

  • Division or region

  • Location detail (e.g. track name, platform number)

  • Add media

  • Conducted on

  • Description of work or task

  • Is the task Safety Critical?

  • Persons conducting engagement

  • Has Target Zero training been completed?

Description of the engagement / discussion

  • Record of safety discussion (Record any observations made or discussions held)

  • Please add a photo

  • Type of Hazard (if present):

  • Please add a photo

  • Safe Practice/ Unsafe Act or Practice

  • Safe Practice / Unsafe Act or Condition
  • Is there a Safe Practice or Unsafe Act or Condition?

  • People

  • Plant & Equipment

  • Practices

Details of any immediate or agreed actions

  • Are there any immediate or agreed actions?

  • Action
  • Actions - Corrective (short term fix – e.g. remove hazard) or Preventive (long term fix e.g. redesign procedure)

  • Owner

  • Due Date

Completion/ Summary

  • Please save completed forms herein ‘Safety Leaderships’ folder on G: Drive

  • Have actions entered into SJAMS Action Management tool (if applicable)?

  • Has a Hazard report been completed and issued to line manager (if applicable)?


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