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Safety Performance Report
This Safety Performance Report template provides the perfect framework for you when you need to organize your report at a high executive level. There are four sections: Leading Indicators, Competence, Process, and Lagging Indicators. You can score each section as a Red Light, Amber Light, or Green Light. A definition for each state is listed in the Safety Performance Report notes section.

Free Sample Template
Format: Word PDF
# of Pages: 1
Printable: Yes

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Safety Performance Report TemplateForm 1213
Format: Word PDF
Category: Employee, Accident
Type: Form
Safety Performance Report

Date: ___/___/_____

Board Leadership =>

Leading Indicators:

Monitoring Results: _____________________________________________________________________________

Audit Results: __________________________________________________________________________________

Attitude Surveys: _______________________________________________________________________________


Skill Training: __________________________________________________________________________________

Management Training: __________________________________________________________________________

Competent Advice: _____________________________________________________________________________


Systems Review: _______________________________________________________________________________

Implementation: _______________________________________________________________________________

Lagging Indicators:

Accident Rate: _________________________________________________________________________________

Ill Health Rate: _________________________________________________________________________________

Absence Rate: _________________________________________________________________________________


Red = Unless there is significant change the given targets will not be met.

Amber = There is a risk of missing the stated targets.

Green = We are well on course to meeting all stated objectives and targets by our target date.