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HSE OBSERVATION CARD HSE OBSERVATION CARD

PART A PART A
TO BE COMPLETED BY OBSERVER TO BE COMPLETED BY OBSERVER
SUBMITTED BY: SUBMITTED BY:
DATE: DATE:
UNSAFE BEHAVIOR NEAR MISS UNSAFE BEHAVIOR NEAR MISS SAFETY HAZARD
NON-CONFORMANCE HSE IDEA NON-CONFORMANCE HSE IDEA OTHERS
SAFETY HAZARD OTHERS
DESCIPTION DESCIPTION

SUGGESTED REMEDIAL/CORRECTIVE ACTION

PART B PART B
TO BE COMPLETED BY HSSE TO BE COMPLETED BY HSSE
CARD NO: CARD NO:
CORRECTIVE ACCTION: YES NO CORRECTIVE ACCTION: YES NO
CLOSE OUT DATE: CLOSE OUT DATE:
SIGNATURE SIGNATURE
REMARKS
HSE OBSERVATION CARD
PART A
TO BE COMPLETED BY OBSERVER
SUBMITTED BY:
DATE:
UNSAFE BE NEAR MISS
NON-CONF HSE IDEA
SAFETY HAZOTHERS
DESCIPTION HSE OBSERVATION CARD
PART A
TO BE COMPLETED BY OBSERVER
SUBMITTED BY:
SUGGESTED REMEDIAL/CORRECTIVE ACTION DATE:
PART B UNSAFE BE NEAR MISS
TO BE COMPLETED BY HSSE NON-CONF HSE IDEA
CARD NO: SAFETY HAZOTHERS
CORRECTIVE ACCTION: YES DESCIPTION
CLOSE OUT DATE:
SIGNATURE
REMARKS
SUGGESTED REMEDIAL/CORRECTIVE ACTION
PART B
TO BE COMPLETED BY HSSE
CARD NO:
CORRECTIVE ACCTION: YES
CLOSE OUT DATE:
SIGNATURE
REMARKS

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