Ventia Safety - Near Miss / Unsafe Condition Report

• Document Number PROJECT-2073838157-195 (Uncontrolled when Printed)

• The version control will be maintained by the SHEQ team and is controlled via the Safety Equipment Inspections Document 2073838157-15.

• Near miss or Unsafe condition

  Near miss

  unsafe condition

• Site

• Conducted on

  Date

The version control will be maintained by the SHEQ team and is controlled via the Safety Equipment Inspections Document 2073838157-15.

• Description of Hazard or Unsafe Condition:

• Images of Hazard / Unsafe condition

  Media

• Immediate action taken

• What do you recommend to improve the situation:

• Contact Name (optional) :

• Contact Number (optional) :

• DTL / Supervisor Name (Required) :

• THANK YOU FOR TAKING TIME TO REPORT SO WE CAN KEEP YOU SAFE AT WORK

• Name of SHEQ Advisor managing follow up:

• Action Taken:

• Date:

• Date Entered into VenSafe:

• VenSafe ###:

• Date Entered into SWIRL:

• SWIRL ###:

• Communication Back to DTL / Supervisor:

• Signature of DTL / Supervisor agreement of work completed:

  Sign

• everyone safe everyday