Safety Observation System (SOS) Report Form
A SOS is an unplanned event or condition that could have reasonably resulted in personal injury or illness, equipment or property damage, or an environmental excursion. Some examples include: Unsafe Conditions, Unsafe Behavior; Events where injury could have occurred but did not, Events where property damage resulted or could have resulted, Events where a control measure was challenged or ignored.
Date Safety Observation Performed
*
/
Month
/
Day
Year
Date
List the employees being observed
Observing Employee Name
*
Observing Employee Email
An email is required to receive a copy of the report.
Supervisor's Name
Supervisor's Email
example@example.com
Project Name and Number
client name is also acceptable
Hazards/Unsafe behaviors
Lack of PPE
Severe Weather/Unsafe Driving Condition
Exposure to Extreme Temps (cold/hot)
Exposure to Construction Traffic
Engulfment (Excavation)
Lack of Warning Signage
Exposure to Vehicle Traffic
Contact with Insect/Animal Bite
Fatigue - Exhaustion
Fall (From Elevation)
Fall (Same Level)
Transportation
Lifting - Repetitive Motion
Struck-By
Caught In/Between
Electrocution
Contact with Sharp Object
Exposure to Chemical
Oxygen Deficiency
Fire Hazard
Improper Storage or Use of Equipment
Lack of Guarding /Shielding
Lack of Housekeeping - Sanitation
Lack of Light - Illumination
Other (Use "Additional Info" Section)
Safety Observation Type
Unsafe Behavior
Unsafe Conditions
Property Damage With No Injury
Near Miss
Positive Report only
Describe the Safety Observation (What happened)
*
Do not use individual names if you have seen an unsafe practice
Take Photo
Take Photo
Describe the Corrective Action: (How can we improve the observed condition or behavior?) (Be Specific)
Date Corrective Actions to be completed
/
Month
/
Day
Year
Date
Check the most likely Consequences of the Hazard Observed
*
Negligible
Minor (First Aid)
Serious (Medical Treatment/Recordable)
Major (Hospitalization)
Catastrophic (Fatality)
Probability or Frequency this Hazard is Encountered
*
Remote
Rarely
Likely (Once a week)
Almost Certain (Multiple times a week)
Highly Likely (Daily occurrence)
Additional Follow-up Information
Use for follow up information gathered as the issue is closed out
Person Responsible for Completing Corrective Actions
*
Email of the Person Responsible for Completing Corrective Actions
example@example.com
Safety Observation System (SOS) Status
*
Open
Closed
Safety Observation System (SOS) Closure Date
-
Month
-
Day
Year
Date
Submit
Should be Empty: