Safety Observation Report

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 Pipe Yard Coil Yard Other

3 Report Type * -- Select Report Type -- Incident Near Miss Unsafe Condition Unsafe Act Suggestions 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 Other

5 Risk Level *

6 Description of Issue *

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7 Injury Reported *

8 Reporter Name (Optional)