PSSR Exercise Submission Form
Submit and review your Pre-Startup Safety Review (PSSR) exercise results for evaluation and continuous improvement.
Participant Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Date of Exercise
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Exercise Location
*
Role During Exercise
*
Please Select
Team Leader
Team Member
Observer
Safety Officer
Other
Exercise Objectives
*
Methods Used During Exercise
*
Checklist Review
Site Walkdown
Team Discussion
Documentation Review
Other
Findings or Issues Identified
*
Self-Assessment of Exercise Effectiveness
*
1
2
3
4
5
Suggestions for Improvement
Supervisor/Reviewer Comments (if applicable)
Upload Relevant Documents or Photos (if any)
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Participant Signature
*
Submit Exercise
Submit Exercise
Should be Empty: