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while cleaning burr, housekeeping lady found without chappels in the shop floor. Chance of burr may be sticking to the foot and chance of any things will fall down and create injury on the foots all the peoples enterning shop floor should wear safety shoes.relevent department heads and safety person should monitor and ensure proper PPE's inside factory premises WHAT COULD HAVE HAPPENED? HOW WE CAN CORRECT IT? ACTION CLOSED (YES /NO) ? ACTION CLOSED DATE ACTION CLOSED TIME CLOSED BY NAME OF THE REPORTER Saranya TIME AND DATE 3.00 PM ,01.09.15 POTENTIAL INCIDENT/NEAR MISS REPORT FORM DATE DEPARTMENT 01.09.15 HR & ADMIN Housekeeping Burr cleaning area PROCESS LOCATION REPORTAND PROTECT REPORT ALL UNSAFE ACTS/UNSAFE CONDITIONS/NEAR MISS DETAILS OF OBSERVATION:

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Page 1: Potential Incident Report Form

while cleaning burr, housekeeping lady found without chappels in the shop floor.

Chance of burr may be sticking to the foot and chance of any things will fall down and create injury on the

foots

all the peoples enterning shop floor should wear safety shoes.relevent department heads and safety person

should monitor and ensure proper PPE's inside factory premises

WHAT COULD HAVE HAPPENED?

HOW WE CAN CORRECT IT?

ACTION CLOSED (YES /NO) ?

ACTION CLOSED

DATE

ACTION CLOSED

TIMECLOSED BY

NAME OF THE REPORTERSaranya

TIME AND DATE3.00 PM ,01.09.15

POTENTIAL INCIDENT/NEAR MISS REPORT FORM

DATE

DEPARTMENT

01.09.15

HR & ADMIN

Housekeeping

Burr cleaning area

PROCESS

LOCATION

REPORTAND PROTECT

REPORT ALL UNSAFE ACTS/UNSAFE CONDITIONS/NEAR MISS

DETAILS OF OBSERVATION:

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