Safety Observation
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Contractor
*
Please Select
RORE
OTIS
KB Electric
Honolulu Fire Protection
Phoenix Pacific (Fire Alarm)
Quillopo Painting
Other
LEVEL
*
Please Select
Level 1
Level 2
Level 3
Level 4
Level 5
Level 6
Level 7 (Attic)
COSA
Area
*
Elevator 1 Cab/ Hositway/ Pit
Elevator 2 Cab/ Hositway/ Pit
Elevator 3 Cab/ Hositway/ Pit
Elevator 4 Cab/ Hositway Pit
Machine Room Elevators 1 & 2
Machine Room Elevators 3 & 4
Level 7 Staging Area
East Staircase
West Staircase
COSA
Other
Personnel Involved (If Applicable)
Observation
*
Follow Up Required?
*
Please Select
YES
NO
N/A
Coaching Moments
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Submitter's Name
First Name
Last Name
Email
example@example.com
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