HSE Report Basic Form for Educational Purposes, Lecturer: Mohammed Al-Sanhani, YEMEN 2021

Report Number Reporter Name

Report Date Event Area
Describe the Hazard(s)
Hazardous Condition(s)

Unsafe/Inappropriate Behavior(s)

Possible Accident

Your First Action to Prevent it or to Reduce it

Recommended Corrective Action(s): Engineering controls. Ideas that correct tools,

equipment, machinery, materials, facilities, environment through redesign, substitution,
replacement, barriers, ventilation, enclosure.

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 HSE Report
as Basic Form for Educational Purposes, Lecturer: Mohammed Al-Sanhani, YEMEN 2021

Recommended System Improvement(s): Management controls: Ideas that improve safety

programs, policies, plans, processes, procedures, practices, rules, reports and forms

Classification
Type of Hazard Its Directly Effect might be on:

Chemical Hazard Physical Hazard

Environment
Bio - Hazard Technical Hazard
People Safety
Ergonomic Hazard Psycosocial - Hazard
People Health
Near miss Accident

Risk Assessment BEFORE Your First Residual Risk Assessment AFTER Your
Action First Action

Risk Risk
Assessment Assessment

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