Safety interaction form checklist
Records interactions about safety
What does this form include?
This form contains 11 sections:
What was the task observed?
Observation Category
Section 1: Observation Report
- The observed behaviour was:
- The observed conditions were:
What did the observer say? (e.g. questions asked, positive recognition given)
What was the worker's response during the interaction?
Section 2: Improvement Actions
- Are follow up actions required?
What follow up actions are required?
Who will perform follow up actions?
When is the follow up due? Date
Date follow up action was completed Date
Section 3: Safety Interaction Self Assessment
- Did you have a discussion with people?
- Did you give positive recognition? (e.g. Working safely, safe behaviour, safe conditions)
- Did you per-plan the safety interaction?
- Did you engage people in problem solving?
- Did you assess the risks and hazards of the work the people were doing?
- Have you discussed follow up actions with people listed as responsible and set agreed timing for closure?
Use this template