Title Page
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Site conducted
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Conducted on
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Prepared by
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Location
Demographic Data
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Battalion
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Company / Battery
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Mission
Safety Culture
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Commanders have a Safety motto, vision, or goal for this exercise?
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Soldiers know the Safety motto, vision, or goal?
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DD Form 2977's are complete and signed by the appropriate authority for the exercise / mission?
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Safety is addressed in the Operations Order and all subsequent orders?
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The mishap reporting process is clearly defined and displayed prominently?
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All mishaps, injuries, and near miss incidents are being reported and investigated
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Command involvement positively effected the Safety culture with defined Safety objectives and provided adequate resources
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Appointed Unit Safety Officers (USO) are trained in their responsibilities and communicated hazards to Command teams.
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Commanders hold individuals accountable to Safety standards and assure realistic timelines that provide for sufficient mission planning. (20/80 time rule)
Safety Leadership
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Commanders have completed the Leaders Safety & Occupational Health Course (LSC)?
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Command teams have Safety awards and defined criteria for nominations and approvals?
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Commanders have approved Pre-Mishap Plans, Emergency Action Plans, Mishap Logs, Hazard Logs, and similar documents?
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Commanders have appointed qualified Soldiers to perform USO duties?
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USOs are afforded time and resources to perform Safety functions? USOs are not assigned any other additional duties that limits availability for Safety concerns.
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USOs conduct and document daily walk-around inspections?
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Safety recommendations are implemented in a timely manner?
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Based on interviews with Commanders and leaders, what were the top hazard prevention priorities for the mission / exercise?
- Vehicle Accident Prevention
- Drivers Training & Hazards
- Risk Management (RM)
- Mission Safety Briefings
- Slips, Trips, & Falls
- Workplace Hazards
- Personal Protective Equipment
- Weapons Safety
- Hot Weather Injuries
- Electrical Safety
- Physical Training Injuries
- Sports Related Injuries
- Safety Training
- Arms, Ammunition, & Explosives (AA&E)
- Wildlife
- Enviornmental
- Ergonomics
- Other On-Duty Injuries
- Other Off-Duty Injuries
Safety Behaviors
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Are Soldiers using Personal Protective Equipment (PPE) and is there enough PPE available for all Soldiers?
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Soldiers are not taking shortcuts or violating Safety standards?
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Soldiers are adequately supervised and on-the-spot Safety corrections are being made?
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Soldiers know who to report to and how to report a mishap, injury, or near miss.
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Are Soldiers performing unsafe acts?
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Soldiers have a sense of ownership in the Safety program.
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Based on observations, Safety Behavior errors are related to which type(s) of failure?
- Individual Failure
- Leadership Failure
- Training Failure
- Support Failure
- Standards Failure
- None
Safety Training
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Are hazards identified and controls implemented for collective METL tasks?
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Is the unit tracking any type of Safety metrics?
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Are controls in place for remedial or refresher training?
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Are equipment operators properly licensed?
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Was the Pre-Mishap Plan and Inclement Weather Plan rehearsed?
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USOs meet regularly with planners to discuss upcoming training and/or missions?
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Based on observations, is there an Individual or Collective Safety training gap?
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If yes, explain the shortcoming.
Safety Statistics
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Available Strength
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On-Duty Mishaps
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On-Duty Injuries
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Near Miss
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Mishap Rate
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Injury Rate
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Mishap / Injury Log available?