SPECIALITY STEELS
INCIDENT / HAZARD REPORT FORM
Foreman
*
Name
Shift
Date
Date & Time of Incident
-
Day
-
Month
Year
Date Picker Icon
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
:
Hour
00
10
20
30
40
50
Minutes
INCIDENT
Accident
Near Miss
High Potential Near Miss
Hazard
Damage
Plant Damage
Comments
Were there any injuries
Yes
No
Employee Referred to:
Medical Centre
Hospital
None
Contacted Tata Shift Manager
Yes
No
Details
Submit Form
Should be Empty: