Audit

KEPPEL FELS
Hazard Observation Card

Date & Time (remember to change if reporting later) =====>

Location (select from below, and/or add additional information here)

Where / Project No:

Where specifically? Choose from list. =====>

Personnel involved: chose from options below, or add more details if nessesary:

Maersk Drilling

KeppelFells

Third party / others (please specify above)

What happened / what was observed?

What was done about it. (Intervention / conversation took place)?

Work stopped?

Hazard rectified within your capability?

Add a photo....

Unsafe act / condition
==================> Chose from the options below: (multible choices possible)

Lifting operation hazard
Confined space Hazard
Fire & Explosion hazard
Permit / Procedures
Material handling hazard
Work Conditions / people positions
Working at height hazard
Electical hazard
Tools / equipment
PPE
Environmental hazard
Housekeeping

Other:

On a scale of 1 - 100 what was the potential risk of this situation
(risk = severity x propability of re-occurrence)

Need for sketch/drawing? (Optional)

Add drawing
Signature. Name or unique ID + sign to the right. =========>

Push the "export" button, and e-mail the report to Soffian: SHS030@maersk.com

DO NOT push the "Finish" button until you have e-mailed the report.

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.