S afety A udit R eport F orm

TRACK OR AREA:_________ TERMINAL: ______________________________

DATE: ____________________ AUDITOR(S):______________________________

START TIME: _____________ __________________________________________

DURATION: _______________ NO. EMPLOYEES OBSERVED: _____________

SAFETY RULE VIOLATION SRV _______

(Actual observation, or the evidence that a rule has been
violated.)

Unsafe Act UA _______

(An act, obviously unsafe, not covered by a written
rule or practice.)

Unsafe Condition UC ________

(A condition, obviously unsafe.)

Safe Act SA ________

(An act or maneuver performed within safety guidelines.)

OBSERVATIONS CLASS
OBSERVATIONS CLASS

GENERAL COMMENTS