Information
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Document No.
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Audit Titel
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Auftraggeber/Baustelle
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Durchgeführt auf
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Vorbereitet von
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Ort
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Lage von Near Miss gemeldet
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Teammitglieder Name:
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Supervisors Name:
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Schwere Verletzungen Fatality (S.I.F.)?
- Yes
- No
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Schwere Verletzungen Fatality S.I.F. (Precursor)
- No 1 - Did the event involve exposure to acute failure, override, or a failure to use a critical safety feature on a piece of equipment?
- No 2 - Did the event involve exposure to a collapse, overturn or partial/complete failure of equipment/finished goods that was newly erected/built/tested or commissioned?
- No 3 - Did the event involve a Team Member exposure to a fall from height?
- No 4 - Did the event involve exposure to a release of hazardous energy due to ineffective lockout during maintenance, installation, inspection, repair, service or troubleshooting?
- No 5 - Did the event involve exposure to being crushed, trapped entangled or in the line of fire with either a release of significant energy or weight?
- No 6 - Did the event involve the movement of long and/or heavy unbalanced objects?
- No 7 - Did the event involve exposure to potential fire/explosion during hot work on a finished product or with an oxy-acetylene system?
- No 8 - Did the event involve potential or actual contact with "live" electricity?
- No 9 - Did the event involve potential or actual harm to a person from a motorized vehicle (includes operator and pedestrian)?
- No 10 - Was this an actual life altering, life threatening or fatal event?
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Art der Umgebung von Miss gemeldet?
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* Wenn andere bitte auflisten hier
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Beschreibung der Umgebung von Miss gemeldet:
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Legen Fotografie Near Miss, die hier gemeldet
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Beschreibung der sofortigen Korrekturmaßnahmen
