Audit

General Information:

Name:

Enablon No:

Company
Package
Location:

Hazard or Near Miss:

Date and Time:

Shift:

Person Involved (if any):

Equipment Involved (if any):

Impact Type:
Description of Hazard or Near Miss

Severity Ranking

HPH is required where the Potential Severity is a Level 4 or Level 5

Immediate Action Taken

Further Action Required

Supervisor Details

Supervisors Name:

Signature:
Date and Time:
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.