Nick Martin

S.P.O.T.M. Nomination Form - 2464 rev 003

Form# 2464 Rev 003- Safety Person of The Month Nomination Form

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Title Page

Employee Name
Employee Number
Department Name
Department Number
Team Leader Name
Date issue SPOT'D
Date of submission
What concern was identified?

What hazard was controlled?
- Laceration (cut)
- Blocked Exits
- Crush
- Slip/Trip/Fall
- Burn
- Fire
- Explosion
- Other
Name type of hazard
How and when was the concern corrected?
Date

Nick Martin

S.P.O.T.M. Nomination Form - 2464 rev 003

Form# 2464 Rev 003- Safety Person of The Month Nomination Form

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.