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

RATING CRITERIA	
Not Observed	Low	Medium	High	
NA	1	2	3	
Communication:	Observations	Rating	
1.	What do we do to encourage good communication between staff and management on safety issues, problems and solutions?			
2.	Are the communication methods we use effective at getting the safety message(s) across?			
3.	Is there a small change we can make to improve staff communication and address any barriers to communication?			
Leadership for safety:	Observations	Rating	
4.	Can we better stress and highlight to our managers and leaders the importance of leadership to safety?			
5.	How can we improve the way we develop good leadership practices in our current and future leaders?			
Teamwork:	Observations	Rating	
6.	How do we encourage staff to work in teams to address and solve safety issues and problems?			
7.	How can we improve the way we develop the teamwork skills of our staff so they can work even more effectively in teams?			
Safety considered in decision-making:	Observations	Rating	
8.	What processes do we have in place to ensure safety is considered in operational decisions?			
9.	How do we encourage staff to consider safety when making operational decisions?			
Situation awareness:	Observations	Rating	
10.	How do we encourage staff to stop and think in performing their task to ensure that they are performing the work safely?			
11.	What tools or procedures do we give staff to help them maintain good awareness of the potential risks involved performing their task?			
12.	What tools or procedures do we give to staff to help them know when to stop work should an unsafe condition(s) arise?			
ACTIONS:
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