Safety Observation Action Report
(SOAR)
“I saw something and I did something!”
Submit SOAR
(Please print clearly)
Date:
Time: 10:20 a.m.
04/25/17
Facility:
Cabinet Shop
Observation:
☐ Unsafe Act/Unsafe Condition
✔ Safety Suggestion
☐
☐ Near Miss Incident
(Safety Hazard)
Description:Labels not legible
✔ Yes
☐
Did You Stop the Job?
☐ No
Immediate Action Taken:
Instructed operator to replace or relabel bottles.
Action to Prevent Recurrence:
Further Action or Help Needed:
Your Name:
Housekeeping
Slips/Trips/Falls
Ladders & Stairs
PPE
Communications
Machine Safeguards
Received By:
☐ No
Your Email:
Del Forbes
For Safety Department Use ONLY:
☐ A.
☐ B.
☐ C.
☐ D.
☐ E.
☐ F.
✔ Yes
☐
☐ G.
☐ H.
☐ I.
☐ J.
☐ K.
☐ L.
Del.forbes@greenpnt.com
_____
Material Handling
Industrial Trucks (forklift)
Tools & Equipment
Fire Protection
Confined Spaces
___________
☐ M.
☐ N.
☐ O.
☐ P.
✔ Q.
☐
LOTO
Work Practices
HAZCOM
Ergonomics
Other
Evacuations
Date Received
Corrective Action:
Action Owner:
Date Action Completed:
Target Date:
Initials: