Safeguarding Action Item Sign Off Sheet

Safeguarding System: Recommendation Identification: Recommendation Priority:

Recommendation Description:

Recommendation Outcome:

Deficiencies:

Master List Update Bowtie/Issues List Update HSEC Task List Update Redline Updates* MOC Required for Resolution* SG Manual Update

Required Required Required Required Required Required

Completed Completed Completed Completed Completed Completed

Evaluated By: Date: Sign Off (ALL Completed & Cancelled SG Action Items) Safeguarding Focal Point: Date: Technical Team Leader: Date: Sign Off (ALL Cancelled SG Action Items) Maintenance Sup't (excluding Fields): Date: Operations or Field Superintendant: Date: Sign Off (ONLY HIGH & SERIOUS Cancelled SG Action Items) Complex Manager: Date: * Note: 1. Redline Updates refer to corrections relative to SG action item for which there are changes to Critical Information (refer to critical info list in BSOM) 2. If MOC is required for resolution of SG action item, include W.O. number in the recommendation outcome section.