Visible Felt Safety Leadership

• Area of Observation

  Select FGO HGO 1 HGO 2 CCD 1 COS Crushing

  • FGO
  • HGO 1
  • HGO 2
  • CCD 1
  • COS
  • Crushing

• Conducted on

  Date

• HSE Repsentative

  Dominic Meidom

  Rossie Philip

  Michael Palasip

  Michelle Banono

  Johnson Taia

Scheduled Observer 1

• undefined

Scheduled Observer 2

• undefined

Permit Number if applicable

• Yes

  No

  N/A

• Positive Work Area Management Identified

  Yes

  No

  N/A

• What are they?

• Opportunities to improve Work Area Management

  Yes

  No

  N/A

• What are they?

• Did the observation present an opportunity to complete a CCV

  Yes

  No

  N/A

• Did the observation present an opportunity to complete a CCV

  Yes

  No

  N/A

• Provide the CCV title

• Were there non-compliance found?

  Yes

  No

  N/A

• Details of the Non-Compliance

  Media

• Name Signature-HSE Rep

  Sign

• Name Signature-Observer 1

  Sign

• Name Signature-Observer 2

  Sign