This report is to be completed and submitted after every Safety Reset session held at your site.

Note you will be asked to upload some photos and a PDF of any printed feedback forms - so have those ready to go.

The information you provide will help to improve future Safety Resets. Thank you.

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* 1. What is the name of the site/office hosting this Safety Reset?
If your site will host more than 1 session, please ensure you use exactly the same format for the name for every report. 

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* 2. Who is the site operator?

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* 3. What industry sector category does your site belong to?

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* 4. What date was this Safety Reset session?

Date

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* 5. How many people attended this Reset session? 

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* 6. How many of each employee type attended?

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* 7. How long did the Safety Reset run for? 
Choose from the options below.

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* 8. How interested were attendees in each segment of the Safety Reset?
This is reflected by the attendees' attention, participation in discussions, and your overall observation.

  Uninterested Interested Very interested
Introduction & Minister's video
Discussion - Why stop for safety?
Safety culture & Heathrow video
Discussion - Managing safety & Safety share
Video - Story 1
Discussion - Checklists
Discussion - Reporting
Video - Story 2
Discussion - What's next?
(optional) Guest speaker

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* 9. What were the top 3 safety & health issues discussed at the Safety Reset session? 
For example: workforce issues, inadequate training, gas monitoring etc 

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* 10. Will your site develop any projects as a result of Safety Reset discussions?
For example, developing new procedures, campaigns, operating models etc

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* 11. Were attendees provided with the online feedback survey link and/or printed survey copies?

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* 12. Please scan any printed feedback forms into a PDF and upload here.

PDF, DOC, DOCX file types only.
Choose File

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* 13. Please upload some photos taken at the session that can be used for reporting and potentially social media (i.e. public display).

JPG, JPEG file types only.
Choose File

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* 14. Did you use the presentation content that was supplied?

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* 15. Was the Safety Reset pack you were sent helpful in guiding you through preparing and presenting your session?

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* 16. Who can we contact if we require information about this session?

T