Event Report

• Project Number: MN4144

• Person reporting Event

  Select Joel Mclean Stefan Hurley Tony Henderson Ellah Black Blair Hickey Andrew Laws Andri Permadi Brett Draper Chris Osbourne Clint Hill Other

  • Joel Mclean
  • Stefan Hurley
  • Tony Henderson
  • Ellah Black
  • Blair Hickey
  • Andrew Laws
  • Andri Permadi
  • Brett Draper
  • Chris Osbourne
  • Clint Hill
  • Other

• Enter name

• Conducted on

  Date
• Location
  Address

• Type of Event

  Select Vehicle Accident Injury/Accident Observation/Hazard Plant Condition Environmental Spill/Incident Near Miss Meeting Hazard Property/Matetial Loss Complaint System Improvement Other

  • Vehicle Accident
  • Injury/Accident
  • Observation/Hazard
  • Plant Condition
  • Environmental Spill/Incident
  • Near Miss
  • Meeting
  • Hazard
  • Property/Matetial Loss
  • Complaint
  • System Improvement
  • Other

Risk Assessment

• Likelihood

  Select Certain Likely Moderate Unlikely Rare N/A

  • Certain
  • Likely
  • Moderate
  • Unlikely
  • Rare
  • N/A

• Likelihood Definitions

  

• Potential Consequence

  Minor

  Medium

  Serious

  Major

  N/A

• Potential Consequence Definitions

  

• Risk Matrix

  

• Overall Risk Rating

  Low

  Medium

  High

  N/A

Event Information

• Is this an SBO?

  Yes

  No

• Description of event and initial action taken

Actions/Lessons Learned

• Actions/Lessons Learned

Description

• Further action to be taken or learnings to be shared

• Owner

  Select Joel Mclean Stefan Hurley Tony Henderson Ellah Black Blair Hickey Andrew Laws Andri Permadi Brett Draper Chris Osbourne Clint Hill Other

  • Joel Mclean
  • Stefan Hurley
  • Tony Henderson
  • Ellah Black
  • Blair Hickey
  • Andrew Laws
  • Andri Permadi
  • Brett Draper
  • Chris Osbourne
  • Clint Hill
  • Other

• Enter name

• Completed?

  Yes

  No

• Expected due date?

  Date

• Date completed?

  Date

Finish Event Report

• Have you discussed all actions/lessons learned with those involved?

  Yes

  No

• You must discuss all actions/lessons learned with those involved before submitting this Event Report to the appropriate person. Please do so now and reselect Yes for this question once complete.

• Event Photos

Photos

• Event Photo

  Media

• Signed

  Sign

• Date

  Date