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  • Observation Nearmiss Report Card Rev1

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    citra
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    This document is a hazard observation and near miss report form from Chevron Geothermal Indonesia. It contains sections for detailing the incident, site verification by a supervisor, and an investigation by HES (Health, Environment, and Safety) personnel. The form is used to document hazards observed or near misses, the immediate corrective actions taken, and any follow up actions needed to address the root causes.

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    Observation+Nearmiss+Report+Card+Rev1

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    This document is a hazard observation and near miss report form from Chevron Geothermal Indonesia. It contains sections for detailing the incident, site verification by a supervisor, and an investigation by HES (Health, Environment, and Safety) personnel. The form is used to document hazards observed or near misses, the immediate corrective actions taken, and any follow up actions needed to address the root causes.

    Droits d'auteur :

    © All Rights Reserved
    Téléchargez comme PDF, TXT ou lisez en ligne sur Scribd
    Signaler comme contenu inapproprié
    183 vues1 page

    Observation Nearmiss Report Card Rev1

    Transféré par

    citra
    This document is a hazard observation and near miss report form from Chevron Geothermal Indonesia. It contains sections for detailing the incident, site verification by a supervisor, and an investigation by HES (Health, Environment, and Safety) personnel. The form is used to document hazards observed or near misses, the immediate corrective actions taken, and any follow up actions needed to address the root causes.

    Droits d'auteur :

    © All Rights Reserved
    Téléchargez comme PDF, TXT ou lisez en ligne sur Scribd
    Signaler comme contenu inapproprié
    sur 1

    Chevron Geothermal Indonesia.

    Ltd

    Hazard Observation & Near miss Report Form


    Laporan Bahaya & Hampir Celaka
    SECTION 1 DETAIL INFORMATION/INFORMASI DETAIL
    (FILLED BY REPORTER/ DIISI OLEH PELAPOR)
    Date
    Tanggal

    Department :
    Departemen

    Time :
    waktu

    Location :
    Lokasi

    Reported by :
    Dilaporkan oleh

    Supervisor in charge :
    Supervisor lapangan

    Company :
    Perusahaan

    Equipment/Material owner :
    Pemilik peralatan/barang

    Detail of Hazard observation/Near miss/Uraian mengenai obervasi bahaya/hampir celaka :

    Immediate Corrective Action/Tindakan Perbaikan yang dilakukan:

    SECTION 2 SITE VERIFICATION /VERIFIKASI LAPANGAN


    (Filled by Supervisor/ Diisi Oleh Pengawas)

    HAZARD OBSERVATION
    Date recieved :
    Tanggal laporan diterima :

    NEAR MISS

    Time :
    waktu

    Location of event :
    Lokasi kejadian

    Immediate Action take/Tindakan Perbaikan yang dilakukan:

    Supervisor Name & sign

    Nama Supervisor & tanda tangan

    SECTION 3 HES PERSONEL VERIFICATION/ VERIFIKASI PETUGAS HES


    (Filled by HES/ diisi oleh Petugas HES)
    *Level investigation/Level investigasi:

    Investigation Method/Metode Investigasi:

    5-Why (untuk level 1)

    Why Tree (untuk level 2 &3)

    3 (Conduct full investigation)


    Action/Tindakan

    By/Oleh

    1.

    ....

    ..

    ..

    2.

    ....

    ..

    ..

    3. ....
    4. ....

    ..
    ..

    Target Date

    ..
    ..

    HES Specialist:

    Department Manager:

    ______________________________

    ____________________________

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