Date:		
Area(s) examined:		
Follow-up actions:		

RATING CRITERIA	
Not Observed	Low	Medium	High	
NA	1	2	3	
Ability to respond:	Observations	Rating	
1.	Do we frequently identify possible events or scenarios which we may need to respond to, and do we consult with staff to help identify them? 			
2.	How frequently do we test our ability to respond to an incident or event?			
3.	How do we ensure that our response capability is sufficient to respond appropriately to these possible identified scenarios?			
Ability to monitor:	Observations	Rating	
4.	Is there a way we can improve the way we track how our systems or operations are performing to ensure they are performing safely? 			
5.	How do we ensure that our operations are not drifting or deviating from expected performance?			
6.	What processes or practices do we follow if we find that our operations deviate from expected performance?			
Ability to anticipate:	Observations	Rating	
7.	How frequently do we look into the future to identify potential opportunities and threats to safety?			
8.	Do we note down these potential opportunities and threats and consult with staff to ensure we are adequately prepared to deal with them? 			
9.	How can we improve our processes to better monitor and detect future opportunities and threats in safety as they arise?			
Ability to learn:	Observations	Rating	
10.	What indicators, incidents or events do we use to learn from to improve the safety of our operations?			
11.	How do we improve the way we implement the lessons we identify from incidents, events and learnings?			
12.	Do we share these lessons with other parts of the organisation, and how can we improve the way we communicate them? 			
13.	How do we ensure the lessons we identify as needing to be learned are in fact learned?			
ACTIONS:
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