Safety Observation Form

Basic Information

1. Time *This question is required.

2. Date (mm/dd/yyyy) *This question is required. This question requires a valid date format of MM/DD/YYYY.

calendar

Observation Mode *This question is required.

Type of Docks Observation *This question is required.

Safety and Operational Skills Assessment

Type of Rail Observation *This question is required.

Type of Trucks Observation *This question is required.

Type of Packaging / Warehouse Observation

Type of Tankfarm Observation

Type of Maintenance Observation

Type of Generic Observation

Type of Sustainability Observation

Type of Laboratory Observation

Type of PSMS Observation ( Exxon Only)

Type of Engineer Stop Test *This question is required.

Method of Viewing Observation *This question is required.

Department Number *This question is required.

Please Choose from the Following options *This question is required.

Please choose from the following options (Sustainability): *This question is required.

Please choose from the following options (Railcar Repair): *This question is required.

Workgroup
Employee Name

3. Unit name / Location

Workgroup
Unit Name

FRA Assessor Name *This question is required.

Observer Name *This question is required.

Please type in Observer's Name (Last, First) if not listed in menu above

Crew Lead Name (if not applicable, enter "NA") *This question is required.

Data Load Status