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See Say Stop Educate

See Say Stop Educate

Thank you for participating in our Near-Miss Reporting program.
37Questions
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  • 1
    Type your name please.
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  • 2
    Please Select One
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  • 3
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  • 4
    Please select your supervisor and they will be sent this information.
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  • 9
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  • 10
    Please Name Your Supervisor
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  • 11
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  • 12
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  • 13
    select where
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  • 14
    select where
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  • 15
    select where
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  • 16
    Where did this observation take place? Example: Fab area, Laydown Yard, Process Area
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  • 17
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  • 18
    The date time of event/observation
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    AM
    • AM
    • PM
    Pick a Date
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  • 19
    Select all that apply
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  • 20
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  • 21
    (Serious Injury/Fatality)
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  • 22
    Select the best option of the LCS that represents why you choose yes on SIF?
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  • 23
    Safety Observation Report (SOR) documents and records potential hazards or unsafe conditions or procedures in the workplace and the facility.
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  • 24
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  • 26
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  • 27
    What type of Electrical Issue
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  • 28
    Extreme Heat/Cold
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  • 29
    What was the issue?
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  • 30
    Which type of riging?
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  • 31
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  • 32
    Were other options evaluated?
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  • 33
    If the issue was with PPE please select which one
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  • 34
    What category of fall prevention?
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  • 35
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    Ok
    quoteCreated with Sketch.
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  • 36
    (Remove the hazard, replace, repair or retrain in the proper procedures for the task)
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    quoteCreated with Sketch.
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  • 37
    If you work in an area where cameras are permitted. Please be aware of cellphone policies.
    Drag and drop files here
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    Max. file size: 10.6MB
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  • 38
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