Title Page

  • Program

  • Location
  • Project

  • Contractor

  • CI Reference Number

  • Date

  • Prepared by

  • INSTRUCTIONS:
    -------------------------------------
    1. Fill in the blanks and answer “Low”, “Medium”, ”High”, “Very High” for the applicable question.
    2. Add photos and notes by clicking on the paperclip icon.
    3. To add a Corrective Measure click on the paperclip icon then "Add Action", provide a description, assign to a member, set priority and due date.
    4. Complete audit by providing digital signature.
    5. Share your report by exporting as PDF, Word, Excel or Web Link.

Observation

  • Observation: (Click "Add Item")

  • Item
  • Observation

  • Bow-Tie Category

  • Observation Type

  • Person Accountable on Project

  • Risk Consequence

  • Due Date

  • Close out Action(s) to be taken

  • Closed date

  • Desksite Number of close out evidence

  • Scroll up and click "+Add" to add more.

Completion

  • INSPECTION (REPRESENTING TPD) | Rail Safety Specialist

  • Name and Signature

  • SITE REPRESENTATIVE | Project Safety RCR

  • Name and Signature

  • ATTENDEE | ST Interface Manager

  • Name and Signature

  • ATTENDEE: (Click "Add ATTENDEE")

  • ATTENDEE
  • Representing

  • Position

  • Name and Signature

  • Scroll up and click "+Add" to add more.

  • COPY TO

  • COMMENT BY INSPECTOR/REVIEWER

  • COMMENT BY ATTENDEE

  • Contractors Notes/Comments

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.