Safety Observation Card sample. Edit it or build your own.

Safety Observation Card Form

A quick, easy to fill out safety observation card form including date, location, observation type, description, and action taken. Checkout the Forms Library »

Safety Observation Card - Printable PDF
Download a printable Safety Observation Card (PDF).

What is a Safety Observation Card?

A safety observation card is a very quick form where employees identify a potential hazard and report it to their leadership group.

A safety observation is not something that resulted in a Near Miss or an Incident, but is a seemingly harmless diversion from best practices and procedures which can become a near miss or incident if ignored for long enough. In some cases, EHS leadership will also have their team fill out "safe" observation card to highlight and honor team members who are following the correct safety procedures.

Types of Safety Observations

Safety observation cards typically fall in the category of:

  • Unsafe Act - e.g. a team member climbed a ladder with both hands carrying tools
  • Unsafe Conditions - e.g. a nail is sticking up out of a board
  • Safe Observation - identifying a team or team member who is correctly following procedures

Most observation cards will have the observer describe the unsafe action in words and will include a section to describe what action was taken to change or remove the unsafe. For more severe situations, the employee may issue a "Stop Work" requiring that all team members on site stop until the hazard is addressed.

“At Fortis Energy Services, we implemented KPA EHS at the end of 2018 and are beginning to see clear benefits. Observations and JSA’s are being completed at a 150% increase versus using the paper copy. Training and notices are communicated directly to the employee in an instant.”
- Fortis Energy
Recipient of the 2019 Excellence in Safety Award, North Dakota Petroleum Council

This form is a sample report which can be imported into your KPA EHS account. All forms including this one can be easily modified to fit your organization's policies and procedures.

Don't have a KPA EHS account? Download the printable Safety Observation Card PDF form so your team can fill out a paper copy.

Check out the forms library.
Check out the forms library.

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