Work Metrics: Online Induction Software and Online Induction System Australia

Field Safety Incident Reporting Portal 01

Name of person reporting incident *

Franchise Name *

Engineer Name

State *

Region *

Customer Name *

Sub Customer name *

Name of the Activity *

Detail of SO Number or Incident ID or Survey Ref No *

VSAT IP

Date of Safety Event *

Time of Safety Event *

Date of Reporting *

Time of Reporting *

Address of the location *

Type of Incident *

Root Cause of Observation

Corrective Action Taken to Close Observation

Preventive Action Taken to Resolve the Observation Permanently

Root Cause of Near Miss

Corrective Action Taken to Close Near Miss

Preventive Action Taken to Resolve the Near Miss Permanently

Denied to work due to Observation

Denied to work due to Near Miss

Is Their any Injury

Is Their Loss of Property

Description of Incident

Upload Relevant Photographs

Impact Level

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