Location
Date
Date
Name of person reporting
Observation
Near Miss
Unsafe Act
Unsafe Condition
Safe Behaviour
Situation Type
Select
Production, Assembly equipment
Racks, shelves
Barriers, Guarding
Maintenance activity or area
Ergonomics
Electrical panel or wiring
Stairs, Ladders, Platforms
Forklift Operation
Material positioning
Tool usage
Policies or procedures definition
Signs or communication
LOTO
Clutter
Pinch points or sharp edges
PPE
Floor surface condition
First Aid box and Eye wash
Passages, exits, aisles, walkways
Fire prevention
Crane, hoist, lifting elements
Containers labelling
Waste management
Office activities
Driving
Production, Assembly equipment Racks, shelves Barriers, Guarding Maintenance activity or area Ergonomics Electrical panel or wiring Stairs, Ladders, Platforms Forklift Operation Material positioning Tool usage Policies or procedures definition Signs or communication LOTO Clutter Pinch points or sharp edges PPE Floor surface condition First Aid box and Eye wash Passages, exits, aisles, walkways Fire prevention Crane, hoist, lifting elements Containers labelling Waste management Office activities Driving
Location Type
Select
Lab
Maintenance/Shop/Service
Manufacturing
Office
Warehouse/Distribution
Offsite_Travel
Parking, Exterior
Lab Maintenance/Shop/Service Manufacturing Office Warehouse/Distribution Offsite_Travel Parking, Exterior
Root Cause
Select
Environment & Housekeeping
Machine & equipment
Materials (Failure/ Dimension/ Weight)
Procedure & Instructions
Employee action
Workplace Ergonomics
Environment & Housekeeping Machine & equipment Materials (Failure/ Dimension/ Weight) Procedure & Instructions Employee action Workplace Ergonomics
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Production FXUK
Safety Incident Report
Used to report near misses, unsafe acts, unsafe conditions and good practice safe behaviours.
The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions.
The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice.
You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction.
You should independently determine whether the template is suitable for your circumstances.
