Stop Work Authority Documentation Form

Records the exercise of stop work authority, including the hazard observed, work stopped, notifications made, corrective actions, and resolution before work resumes.

Submission Notice

• Read this before submitting
• I understand this form records a safety event and may be used for audit trail and corrective action tracking.

Event Details

• Date of stop work event
• Time of stop work event
• Site / area / unit
• Reported by
• Reporter role
• Work activity in progress
• Was contractor work involved?

Hazard Observed

• Primary hazard type
• Describe the hazard observed
• Immediate risk if work continued
• Did the event involve injury, near miss, or damage?
• Describe injury, near miss, or damage

Work Stopped and Controls

• What work was stopped?
• Stop action taken
• Interim controls implemented
• Can work resume immediately?
• What must happen before work can resume?

Notifications and Escalation

• Supervisor notified?
• Supervisor name
• Safety team notified?
• Other notifications made
• Notification details

Resolution and Approval to Resume

• Corrective actions completed
• How was the hazard verified controlled?
• Authorized by
• Date work resumed
• Time work resumed
• Is follow-up action required after resumption?
• Follow-up actions