ACCIDENT / INCIDENT REPORT
Reference No.
*
ACCIDENT INFORMATION
Title
*
Date of Accident / Incident
*
Time of Accident / Incident
*
Weather Condition of Accident / Incident
Location of the Accident e.g., JKR Premises, Construction Site, Ferry, etc..
CH e.g., CH 123+456.789
+
.
Project Name
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Contact No.
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Accident / Incident Category
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Fatality
Dangerous Occurence
Environment Mishap
Near Miss
Occupational Disease
Occupational Poisoning
Site Accident
Theft / Robbery
Traffic Accident
First Aid Cases
Property Damage
Covid-19 Case
VICTIM PERSONAL DETAILS
Name
Job Title
Employer's Name
Age
Nationality
add
WITNESS PERSONAL DETAILS
Name
Job Title
Employer's Name
Age
Nationality
add
ACCIDENT DETAILS
Casualty Description (Chronology)
HSET Team Action & Response
Root Cause
Number of Fatality
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Corrective/ Preventive Measures
*
Remarks
Attachment
*
*Accept multiple files with 60 MB limit
Photos
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*Accept multiple files with 60 MB limit
Reference
Process
Reference No.
Created By
Created Date
add
REPORTED BY
Name
*
Position
Date
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Submit
10
20
30
40
50
100
Process
Approved Design Drawing
Design Change Request
Incident
Land Acquisition
Land Encumbrances
Land Issue
Land Summary
Method Statement
Material Acceptance
Non Conformance Report
Site Memo / Notice of Improvement
Public Complaint
Progress Update
Request for Inspection
Request for Information Technical
Risk Register
Report Submission
Safety Activity and Response
Site Dairy Log
Site Instruction
Total Safe Man-Hours Work Without LTI
Show
PROCESS
REF. NO.
CREATED BY
DATE CREATED
STATUS
ACTION
ACTIONER
ACTION STATUS
ACTION REMARKS
VIEW