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Safety Observation Report
Safety Department
1
Department
*
-- Select Department --
Production
QC/QA
Maintenance
Utilities
Logistics
Other
2
Choose Location
*
-- Select Location --
Line 1
Line 2
Line 3
Line 4
Line 5
Other
3
Report Type
*
-- Select Report Type --
Incident
Near Miss
Unsafe Condition
Unsafe Act
Other
4
Hazard Category
*
-- Select Hazard Category --
Electrical
Lifting / Crane / Forklift
Slip / Trip / Fall
Chemical / Gases
Spill / Liquid / Oil Leakage
Fire
Working at Height
Confined Spaces
5
Risk Level
*
Low
Medium
High
6
Description of Issue
*
Upload Photo (optional)
Max 5MB | JPG, PNG, GIF
7
Injury Reported
*
Yes
No
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8
Reporter Name (Optional)
All fields marked with * are required
Submit Report
