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KenMor Good Catch Submission Form
Date *
Project *
Submitted By *
Supervisor *
Location *
Section 1: Identifiable Hazards
This good catch clearly identifies a specific hazards or potential hazard.
Description of Identified Hazard or Potential Hazard:
Provide a clear and concise description of the specific hazard or potential hazard that was identified in the specific project or district.
Section 2: Sustainable Solution
The solution is sustainable and requires minimal maintenance to remain effective.
Description of Implemented Solution:
Describe the long-term solution implemented and explain why it requires minimal maintenance or ongoing effort to remain effective and sustainable.
Section 3: Engineering Controls or Greater
The solution involves an engineering control or greater to eliminate/minimize the hazard.
Description of Engineering Controls or greater:
Detail the physical changes made to equipment, processes, or systems and how these changes eliminate or minimize the identified hazard. If applicable, explain how modifications allow safe work around the hazard.
Additional Documentation
Attach any supplementary documents, photos, diagrams, etc., that support the good catch submission.
Attach a photo.
Attach Photo
Attach a second photo if necessary.
Photo #2
Attach a third photo if necessary.
Photo #3
Attach Video
(Note: iOS users cannot attach a PDF)
Attach PDF
Submission Confirmation
I confirm that the information provided in this form is accurate and true to the best of my knowledge.
Acknowledged By: *
Type your full name.
Date *
Send
