Safety Workflow Test Form
Use this form to assess, review, and document the effectiveness of safety workflows in your organization.
Full Name
*
First Name
Last Name
Department or Team
*
Date of Assessment
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Workflow or Process Being Assessed
*
Step-by-Step Workflow Evaluation
*
Rows
Step Completed
Potential Hazard Identified
Control Measures in Place
Step 1
1
2
3
Step 2
4
5
6
Step 3
7
8
9
Step 4
10
11
12
Step 5
13
14
15
Rate the Overall Safety of the Workflow
*
1
2
3
4
5
Were any risks or hazards identified during the workflow?
*
Yes
No
If yes, please describe the identified risks or hazards
Are all safety compliance requirements met for this workflow?
*
Yes, fully compliant
Partially compliant
Not compliant
List any corrective actions taken or recommended
Responsible Person(s) for Corrective Actions
Additional Comments or Suggestions
Submit Assessment
Should be Empty: