DOWNER NEAR MISS Report

• 001 UFB DOWNER

• DOWNER NEAR MISS REPORT

• Downer UFB CHORUS

• Conducted on

  Date

• Prepared by

• Location
  Address

Type of event/Issue

• Service

• Select type of service

  Select Gas Power Telecommunications Water Sewer Stormwater

  • Gas
  • Power
  • Telecommunications
  • Water
  • Sewer
  • Stormwater

• Specific issue

  service mislocate

  service plans incorrect

  service not on plans

• Plant and equipment

• Environment

• Human

Brief description of the event details

• Describe O.S.H.I.T. NEAR MISS EVENT

• Record image if relevant

  Media

Preventative action

• What action is required?

• Manager to be notified.

  Jason Spencer

  Alisdair Durie

  Robert Jugovac

  Michael Maunsell

  Jason Stapp

• Please print your name and sign

  Sign

• This document should be signed and sent to your Project Manager, and the National Operational UFB Zero Harm Advisor.
  Service deviations and offsets on identified networks will be forwarded to the appropriate service asset owner.
  
  This report is for events which have not resulted in harm, I.e. injury or damage. Service strikes must be notified via EAGLE EYE, all injury events must be reported according to Downer UFB and National DNZ Telco FM reporting procedures.