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    1.investigation Report

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    gazzali ..
    This document appears to be an incident/near miss investigation form used to record details of potential incidents. It collects information such as whether the hazard was previously identified, estimated costs, potential for future losses, and whether external reporting is required. The second section is for recording investigation details and performing a root cause analysis to identify hazards present prior to the incident and how they may have contributed.

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    1.investigation Report

    Uploaded by

    gazzali ..
    5 views1 page
    This document appears to be an incident/near miss investigation form used to record details of potential incidents. It collects information such as whether the hazard was previously identified, estimated costs, potential for future losses, and whether external reporting is required. The second section is for recording investigation details and performing a root cause analysis to identify hazards present prior to the incident and how they may have contributed.

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    1.investigation report

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    This document appears to be an incident/near miss investigation form used to record details of potential incidents. It collects information such as whether the hazard was previously identified, estimated costs, potential for future losses, and whether external reporting is required. The second section is for recording investigation details and performing a root cause analysis to identify hazards present prior to the incident and how they may have contributed.

    Copyright:

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

    1.investigation Report

    Uploaded by

    gazzali ..
    This document appears to be an incident/near miss investigation form used to record details of potential incidents. It collects information such as whether the hazard was previously identified, estimated costs, potential for future losses, and whether external reporting is required. The second section is for recording investigation details and performing a root cause analysis to identify hazards present prior to the incident and how they may have contributed.

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    Appendix 9

    Appendices
    INCIDENT/NEAR MISS INVESTIGATION FORM
    POTENTIAL

    Was the hazard identified in a Risk Assessment? Yes F No F

    If yes , what Is the Risk Assessment ID?

    Were specified control measures in place? Yes F No F N/A F

    Estimated cost of the incident F SR F USD F EUR :

    0-1000 F 1000-5000 F 5000-10,000 F 10,000-25,000 F 25,000-50,000 F

    50,000-100,000 F 100,000-500,000 F >500,000 F

    Potential for future loss from similar incidents:

    Likelihood Severity Loss Potential


    People
    Products
    Property
    Environment

    Is this Incident externally reportable? Yes F No F

    If yes, please specify:

    F General Directorate of Civil Defense F Ministry of Municipal and Rural Affairs F Regional Municipality

    F Presidency of Meteorology and Environment F Ministry of Health F Regional Health Authority F Police

    F Insurance F Other, please specify:

    ASIC I VESTIGATIO D TAILS - ROOT CA U SE A ALYSIS

    Post Incident:

    The Incident(s):

    Prior to the incident, identify what hazards were present. Did these hazards contribute to the incident?
    (Please refer to the list of hazards in the Officers Safety Management System Manual)

    Hazard: Why it contributed?


    Hazard: Why it contributed?
    Hazard: Why it contributed?

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