Unlock hundreds more features
Save your Form to the Dashboard
View and Export Results
Use AI to Create Forms and Analyse Results

Forgot Password?
Get Started
OR
Sign UpLogin With Facebook
Sign UpLogin With Google

Stop Work Authority Reporting Form Template

Ensure safety and compliance with effective reporting

When projects are stopped due to safety concerns or issues, timely reporting is crucial. This Stop Work Authority Reporting Form Template helps you officially document work stoppages, ensuring accountability and compliance within your organization. You can streamline communication about hazards, improve safety protocols, and protect your team's well-being with this simple, yet effective tool. It's also designed with WCAG-aligned labels, making it accessible for all users. Experience the ease of creating your report today.

Use this Template (FREE) Live Preview
Reporter full name
Email address
Would you like to remain anonymous on this report?
Yes
No
Site or facility name
Specific location or area
Date work was stopped
Task being performed at the time
Primary reason for stopping work
Immediate danger to life or health
Unsafe condition observed
Unsafe act observed
Change in conditions
Procedure unclear or incorrect
Equipment or tool issue
Environmental condition (weather, lighting, noise)
Other
Please Specify:
Hazards identified (select all that apply)
Please Specify:
Describe the hazard or concern
Was anyone injured or was there property damage?
Yes
No
Potential severity if work had continued
Insignificant
Minor
Moderate
Major
Severe or catastrophic
Unknown
Was there an immediate risk to life or health at the time?
Yes
No
What immediate actions were taken to make the area safe?
Controls applied
Please Specify:
Were the controls sufficient to resume work safely at the time?
Yes
No
Who was notified?
Supervisor or foreman
Safety representative
Project manager
Client or owner
Site control or security
Emergency services
Other
Please Specify:
Did work resume after controls were implemented?
Yes
No
May we contact you for more details if needed?
Yes
No
Signer full name
Signature date
I affirm the information provided is accurate to the best of my knowledge.
Agree
Disagree
{"name":"Reporter full name", "url":"https://www.quiz-maker.com/QPREVIEW","txt":"Reporter full name, Email address, Would you like to remain anonymous on this report?","img":"https://www.quiz-maker.com/3012/images/ogquiz.png"}
Paper art illustration depicting a Stop Work Authority Reporting Form Template for FormCreatorAI article.

When to use this form

Use this form the moment you pause a job for safety. It is ideal when you see a gas smell, unexpected energy, missing machine guards, unstable scaffolding, or conflicting permits. You capture the hazard, who stopped the task, the immediate controls, and what must happen before restart. Frontline workers, supervisors, and HSE teams benefit by getting a clear record that speeds decisions and fixes. If someone was hurt, pair your report with the Employee injury report form. For near misses or damage, link the details to the Incident report form so investigations stay consistent.

Must Ask Stop Work Authority Reporting Questions

  1. What unsafe condition or act did you observe, and what task was in progress?

    This defines the hazard and the exact work context, which helps you triage severity and choose the right controls. Clear detail speeds investigation and prevents vague reports that are hard to act on.

  2. Where and when did you stop the work (date, time, exact location or asset)?

    Precise time and place let you spot trends, isolate equipment, and notify the right team. It also supports traceability for audits and shift handovers.

  3. Who initiated the stop (name, role, company) and who was notified?

    Identifying people creates accountability and ensures the right supervisors, permit holders, and contractors are in the loop. It reduces the risk of an unintended restart.

  4. What immediate controls or barriers did you apply, and is the area currently safe?

    This shows how you stabilized the scene and whether more protection is needed before investigation. On active jobsites, align your notes with the Construction accident report form when relevant.

  5. What corrective actions and authorization are required before work resumes?

    Defining the fix and the approver sets a clear path to a safe restart and prevents drift. If your process needs a formal reference, record it alongside the LS54 Form.

More Forms

Copy/Edit Form Send to Recipients Make a Form w/AI Form Builder Must Ask Questions
  • 100% Free - No Catches
  • Collect Responses Today
  • Tailor to your Look & Feel