Coaching Moment

Stop and think before and during a task

Courage  –  Care  –  Commitment  –  Intervene

  • Make it safe
  • Use the right tools
  • Use the right procedure
  • Reduce risks


    Fields marked with an * are required



    Did the employee clearly understand the task?

    Are there high potential hazards present?

    Did the employee identify all applicable hazards?
    List some of the hazards:


    Were hazards properly mitigated or controlled?
    What was Done?

    Did the employee follow the hierarchy of controls when mitigating the hazards?

    Was the hazard assessment updated and timestamped?


    Was the hazardous assessment coaching completed between leadership and employee? Describe the coaching moment:

    Are controls in place for any additional hazards identified?

    Are all controls engineering administrative and PPE available?

    Did the employee know the emergency process in the area?

    Feedback Given

    Leadership/Coach Feedback:

    Employee Feedback:

    Upload A Photo If Needed (10mb max):