Stop and Think Submission Form

BEFORE A TASK

What could go wrong?

Has anything changed?

How bad could it be?

Am I physically and mentally ready?


DURING THE TASK

Make it safe.

Use the right procedures.

Use the right tools.

Reduce the risk.


AFTER THE TASK

Describe Positive Interventions or observations

Communicate Quality Concerns and task results


STOP IF IT CAN’T BE DONE SAFELY!!!

ID Type*
Alert Notification Level*
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Probability Of Recurring*

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HH:MM

Division*
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(IE : LSD , Intersection, Landmarks)

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If the clients name is not listed above, Type it in here.

Enter Site Supervisor or Safety Contact Name

Site Supervisor or Safety Contact Email Address (Recommended)

Enter An Address
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Describe the hazardous act, condition or the the cause of your Stop & Think

What was implemented or what you do think should be implemented to mitigate this hazard?

Let us know what results you expect from your Stop & Think Submission or select Hazard Control Implement for your Corrective Actions.

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Provide the details of the intervention or observation that positively affected the outcome of an identified hazardous act, condition or situation

Safety Leadership Recognition At-A-Boys

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