Safety Stand-Down Record

Stand-down details

Date *

Site / location *

Project / order #

Led by (print) *

Leader’s role

Reason *

Work stopped at *

Work resumed at *

Minutes

Topics covered

Discussion

Key points discussed *

Concerns, hazards or ideas raised by employees *

Actions to follow up

Anything that must be fixed, bought, changed or trained as a result. Give each a name and a date.

#	What must happen	Owner	Due
1
2
3
4

Attendance

By signing you confirm you attended the whole stand-down. 0 signed.

1

Attendee 1 signature

2

Attendee 2 signature

3

Attendee 3 signature

4

Attendee 4 signature

5

Attendee 5 signature

6

Attendee 6 signature

7

Attendee 7 signature

8

Attendee 8 signature

9

Attendee 9 signature

10

Attendee 10 signature

11

Attendee 11 signature

12

Attendee 12 signature

13

Attendee 13 signature

14

Attendee 14 signature

15

Attendee 15 signature

16

Attendee 16 signature

17

Attendee 17 signature

18

Attendee 18 signature

19

Attendee 19 signature

20

Attendee 20 signature

Leader sign-off

Leader (print)

Employee ID

Date / time

Leader — signature