Safety Observation Tracking Log Form
Use this form to record and track workplace safety observations. Please complete all sections to ensure accurate and actionable reporting.
Date of Observation
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Observer Name
*
First Name
Last Name
Department / Area
*
Location of Observation
*
Type of Observation
*
Please Select
Unsafe Act
Unsafe Condition
Near Miss
Positive Behavior
Other
Description of Observation
*
Severity Level
*
Low
Medium
High
Immediate Action Taken
Persons Involved (if any)
Follow-Up Required?
*
Yes
No
Submit Observation
Should be Empty: