Internal

Safety Status Month/Year : Zone : Owner :

1
2 3 4 S.No Issue Description Identified Category ICA/PCA Responsibility Status
Date
5 6 7 8 9
10 11 12 13 14 15 16
17 18 19 20 21 22 23 24 25
26
27
28
29 30 31

Major Near Miss

Minor Environmental/
Fire
First Aid
Dangerous
Accident Free days Occurrence

Status Jan’24 Feb’24 Mar’24 Apr’24 May’24 June’24 July’24 Aug’24 Sep’24 Oct’24 Nov’24 Dec’24 YTD ‘24

Minor Last Incident Date -

Major

First Aid

Near Miss
Environmental /Fire No. Of Green Days -
Dangerous Occurrence