Monthly Safety Activity Report
Please complete this form to report all safety activities, incidents, and observations for the month.
Reporting Month
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Site/Location
*
Person Completing Report (Full Name)
*
First Name
Last Name
Job Title
*
Email Address
*
example@example.com
Safety Activities Conducted This Month
*
Safety Training Sessions
Safety Inspections
Emergency Drills
Toolbox Talks
Other
Number of Incidents/Accidents Reported
*
Number of Near Misses Reported
*
Hazards or Unsafe Conditions Observed
Corrective Actions Taken
Outstanding Safety Issues
Suggestions for Safety Improvement
Signature (confirming the accuracy of the report)
*
Submit Report
Submit Report
Should be Empty: