Good Catch Form

“Safety By Choice, Not By Chance”

A good catch is a potential hazard that has not resulted in any personal injury or property damage. Some examples of good catches are unsafe conditions, improper use of equipment, use of faulty equipment, or not following proper procedures.It is everyone’s responsibility to report and correct any of these potential hazards immediately. Please use this form to report a good catch and assist in preventing injuries and make our site a safer workplace.
Department
Location
Building: (If Applicable)
Date

MonthDayYear
Date
Time

Hour Minutes

AM/PM Option
Good CatchSafety ConcernSafety SuggestionOther
Unsafe ActUnsafe Condition of AreaUnsafe Condition of EquipmentUnsafe Use of EquipmentOther
Describe the potential incident/hazard/concern and possible outcome.
Safety Suggestion
Name & Subcontractor Company
Date Reported

MonthDayYear
Date
Phone Number (optional)
Email Address (optional)
example@example.com
Should be Empty: