S4-F2 Act of Vigilance Card

General Information

Name

Date

Project Code

Craft Code

Shift

Day Night

Subcontractor

Yes No

AOV Details

Behavior Observation Work Site Condition Quality Observation

Observation Checklist

A/B = Above and Beyond

A/R = At Risk

Near Miss Events must be documented on a driver card and reported immediately. Freeze the scene.
Direct Supervisors must review for quality and additional action required. Initial prior to submitting.
Above and Beyond - Where any worker is found to demonstrate exceptional commitment to working safely.
At Risk - A work condition or worker behaviour poses a risk to health, safety or environment.

4.0 Leadership

4.1 Adequate Pre-Job Meetings

A/B A/R

4.2 Growing Competency and Monitoring

A/B A/R

4.3 Adequate Field Presence

A/B A/R

4.4 Promoting Core Values

A/B A/R

8.0 Planning/Communication

8.1 Hazard Assessments/Permits

A/B A/R

8.2 Meeting/General Written Communications

A/B A/R

8.3 Verbal Communication/Radios

A/B A/R

8.4 Mobilization/Ramp Up/Demobilization

A/B A/R

Description

Act of Vigilance Comments/Brief Description

Action Plan

Describe the immediate action taken to address the behavior/condition

Date Corrective Action Completed

Further Action Required

Yes No

* If further action is required, please immediately notify your supervisor.

Supervisor Name

Supervisor Quality Check Complete

Yes No

S4-F2 Act of Vigilance Card

General Information

Observation Checklist

1.0 Personal Protective Equipment

2.0 Tools, Equipment, and Vehicles

3.0 Work Method

4.0 Leadership

5.0 Work Area/Housekeeping

6.0 Body Positioning/Human Factors

7.0 Procedures/Standards

8.0 Planning/Communication

9.0 Quality

Description

Action Plan