IR2

NATURE OF NEAR MISS/ POTENTIAL INCIDENT.

Makro or Booker

Store address
Date / Time.

Health

Safety

Environment

DESCRIPTION OF INCIDENT.

Picture.

ACTION TAKEN TO RESOLVE ISSUE

Picture.

Job Status

Enter job Number raised

Technician signature
Managers signature
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.