Information
-
Type of incident
-
Name of person reporting
-
Email
-
Telephone
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Gender
-
Age
- Under 20
- 21 - 30
- 31 - 40
- 41 - 50
- 51 - 60
- 61 - 70
- 70+
Details of incident
-
Name of person involved (if different)
-
Business activity
- Corporate
- Energy - power and industrial inspection
- Energy oil and gas offshore
- Management systems
- Marine - existing ship
- Marine - new construction
- Marine - consultancy
- Transportation
-
ENERGY ONLY - Service line
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Type of incident
- Building office related hazard
- Collapse of a structure
- Contact with electricity
- Contact with moving machinery
- Contact with a sharp object
- Deep vein thrombosis DVT
- Fire
- Excessive noise
- Explosion
- Exposure to hazardous radiation
- Fall from height
- General medical issue
- Hit by something moving or falling object
- Hit by something fixed or solid
- Inadequate illumination
- Manual handling activities
- Office ergonomics - DSE
- Other - describe
- Personal attack or assault
- Road traffic accident
- Slip, trip or fall on same level
- Temperature - hot or cold
- Water immersion
- Work related stress
-
Work related
-
Short description of the incident
-
Add media
-
Location of the incident
-
Date and time of incident
Action taken and cause
-
Action taken at the time
-
Underlying cause
- Poor housekeeping
- Hazardous work environment
- Adverse weather
- Inadequate barriers
- PPE unsuitable
- Directly caused by 3rd party
- Equipment defective
- Lack of training
- Horseplay
- Not using PPE (correctly)
- Taking shortcuts
- Lack of rest (exhaustion)
- Effective site management
- Not being observant
- Communication failure
- Correct procedure not followed
- Failure to confirm safe conditions
- Under the influence of drugs / alcohol
- Tight space or restricted movement
- Effective SMS processes / procedures
- Poor illumination
- Repetitive task
- Not concentrating
- None
-
Behaviours
- Correct procedure not followed
- Failure to confirm safe conditions
- Horseplay
- Not concentrating
- Not using PPE (correctly)
- Taking shortcut
- Under the influence of drugs / alcohol
- Not being observant
- Lack of rest (exhaustion)
- Positive safety behaviour
- Good safety culture
- Positive reinforcement of safety
- Effective safety communication
- None
-
Potential Seriousness
-
Once complete please email to kerri.annett@lr.org or jill.bagley@lr.org for entry into SIRS
