FRM-Hazard / Near Miss Report

General Information:

• Name:

• Enablon No:

• Company

  Select Redpath ASD BGC Hutchinson McNab Mainteck Lend Lease General Misc N/A

  • Redpath
  • ASD
  • BGC
  • Hutchinson
  • McNab
  • Mainteck
  • Lend Lease
  • General
  • Misc
  • N/A

• Package

  Select AA030 AA037 CC001 CC006 CX001 CX002 CE012 General Misc N/A

  • AA030
  • AA037
  • CC001
  • CC006
  • CX001
  • CX002
  • CE012
  • General
  • Misc
  • N/A
• Location:
  Address

• Hazard or Near Miss:

  Hazard

  Near Miss

• Date and Time:

  Date

• Shift:

  Day

  Night

• Person Involved (if any):

• Equipment Involved (if any):

• Impact Type:

  Select Safety Environment Equipment Damage Reputation Health Legal/Regulatory Social Material Loss/Business Interruption

  • Safety
  • Environment
  • Equipment Damage
  • Reputation
  • Health
  • Legal/Regulatory
  • Social
  • Material Loss/Business Interruption

Description of Hazard or Near Miss

• Severity Ranking

  Level 1

  Level 2

  Level 3

  Level 4

  Level 5

• 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:

  Sign

• Date and Time:

  Date