Chris Haefele

Well Connected Alliance Green Card Report for Incidents

Used for hazard, near miss, incident reporting (GREEN CARD)

Use this Template

Print as PDF

Use this Template

Go digital today!

Convert your paper checklists into digital forms

Scan this QR code to use this paper checklist on your smartphone or tablet or visit https://safetyculture.com/

Information

Conducted on
Your Name?
Who you work for?

GREEN CARD REPORT

REPORT CLASSIFICATION?
- HAZARD
- NEAR MISS
- FIRST AID
- QUALITY ISSUE
- ENVIRONMENTAL
- IMPROVEMENT
- PROPERTY DAMAGE
- PLANT DAMAGE
- GOOD STUFF
WHERE WAS IT?
- NORTH
- SOUTH
- TUNNEL
- PRECAST
- OFFICE
- WIRI
- M&E
- PLANT DAMAGE
WHAT DID YOU OBSERVE (REPORT)?
WHAT ACTION DID YOU TAKE TO CLOSE OUT / RECOGNITION?
WHAT FEEDBACK DID YOU GIVE TO THE PERSON'S INVOLVED?

Chris Haefele

Well Connected Alliance Green Card Report for Incidents

Used for hazard, near miss, incident reporting (GREEN CARD)

Use this Template

Print as PDF

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.