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    Potential Incident Report Form

    Uploaded by

    Kumaravel
    A housekeeping employee was found cleaning burrs in the factory without safety shoes, putting her at risk of injury from falling debris or burrs sticking to her feet. To prevent such incidents, all people entering the shop floor should wear proper protective equipment like safety shoes, and department heads should monitor PPE compliance. The potential near miss was reported by Saranya on September 1st, 2015 at 3 PM.

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    Potential Incident Report Form

    Uploaded by

    Kumaravel
    29 views1 page
    A housekeeping employee was found cleaning burrs in the factory without safety shoes, putting her at risk of injury from falling debris or burrs sticking to her feet. To prevent such incidents, all people entering the shop floor should wear proper protective equipment like safety shoes, and department heads should monitor PPE compliance. The potential near miss was reported by Saranya on September 1st, 2015 at 3 PM.

    Original Description:

    useful for safety audits

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    A housekeeping employee was found cleaning burrs in the factory without safety shoes, putting her at risk of injury from falling debris or burrs sticking to her feet. To prevent such incidents, all people entering the shop floor should wear proper protective equipment like safety shoes, and department heads should monitor PPE compliance. The potential near miss was reported by Saranya on September 1st, 2015 at 3 PM.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    29 views1 page

    Potential Incident Report Form

    Uploaded by

    Kumaravel
    A housekeeping employee was found cleaning burrs in the factory without safety shoes, putting her at risk of injury from falling debris or burrs sticking to her feet. To prevent such incidents, all people entering the shop floor should wear proper protective equipment like safety shoes, and department heads should monitor PPE compliance. The potential near miss was reported by Saranya on September 1st, 2015 at 3 PM.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
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    of 1

    POTENTIAL INCIDENT/NEAR MISS REPORT FORM

    DATE

    01.09.15

    PROCESS

    Housekeeping

    DEPARTMENT

    HR & ADMIN

    LOCATION

    Burr cleaning area

    REPORTAND PROTECT
    REPORT ALL UNSAFE ACTS/UNSAFE CONDITIONS/NEAR MISS

    DETAILS OF OBSERVATION:
    while cleaning burr, housekeeping lady found without chappels in the shop floor.

    WHAT COULD HAVE HAPPENED?

    Chance of burr may be sticking to the foot and chance of any things will fall down and create injury on the
    foots

    HOW WE CAN CORRECT IT?

    all the peoples enterning shop floor should wear safety shoes.relevent department heads and safety person
    should monitor and ensure proper PPE's inside factory premises

    NAME OF THE REPORTER

    Saranya

    TIME AND DATE

    ACTION CLOSED (YES /NO) ?


    ACTION CLOSED
    DATE

    ACTION CLOSED
    TIME

    CLOSED BY

    3.00 PM ,01.09.15

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