Stop Work Good Catch Form

Good Catch Form

Use this form to report a Good Catch or safety related concern when you use Stop Work authorization or have a Good Catch.
Good Catch: Is the recognition by an employee of a condition or situation that has the potential to cause an event but did not cause one due to corrective action and/or timely intervention by the employee.

Stop Work Authority: Provides employees the responsibility and obligation to stop work when a perceived unsafe condition or behavior may result in an unwanted event.

Near Miss: A Near Miss is an unplanned event that did not result in injury, illness, or damage – but had the potential to do so. Only a fortunate break in the chain of events prevented an injury or damage; in other words, a miss that was nonetheless very near.
Date of the Event

MonthDayYear
Date
Check the type of event*

Good CatchNear MissStop Work Authority
Who is your Regional Safety Manager*

JJ John Bland, 304-627-8891"Catfish" William Watford, 850-851-9574Damone Gasaway, 713-906-3917
Name of Person filling out the form*

First NameLast Name
Email Address*
example@example.com
Location Coordinates
Location of event

Company OfficeField locationOther
What happened?
If applicable take a picture of the issue.
Picture 1
Picture 2
What was done to prevent re-occurrence?
Should be Empty: