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Plant
*
Select Plant
Plant is required
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Department
*
Department is required
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Contractor/Sub-Contractor
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Location/Sub-Location
*
Location/Sub-Location is required
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Shift
*
Select Shift
Shift is required.
Event Date
*
Event Time
*
Enter Valid Date and Time
Event Date & Time is required
Incident At
*
On Site
Off Site
Nature of Injury
*
{{cat.CategoryName}}
Type of Incident
*
{{cat.CategoryName}}
Other Sub Type
Equipment Involved
Select Equipment Involved
If other, provide details
Material Involved
Select Material Involved
If other, provide details
Describe the incident/ unsafe condition/ non-conformity
*
Describe the incident/ unsafe condition/ non-conformity is required
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Immediate Action Taken (Also mention who visited site first and what action was proposed by him? if applicable)
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Details of Worker(s) Involved
*
Employee(s) / Other
*
Name
*
Staff ID
Age
*
Department
Gender
*
Action
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{{victim.Name}}
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Reported By
Name
*
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Department
Contact No.
Invalid Contact Number.
Employment Type
*
Select Employment Type
Employment Type is required
Witness 1
Name
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Department
Contact No.
Invalid Contact Number.
Witness 2
Name
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Department
Contact No.
Invalid Contact Number.
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