Risk Report Form

Project

Audit
Client
Management
Internal Employee
External Employee
SubContractor

Type of Observation

Improvement
Anomaly
Near Miss Accident
Accident
Near Miss Incident
Incident
Environmental Incident
Description of Observations

If you are unsure about the types of observations:

  • Improvement: Actions or suggestions that enhance safety, efficiency, or environmental performance.
  • Anomaly: Any deviation from the norm that may not immediately cause harm but could indicate a potential issue.
  • Near Miss Incident: An event that could have resulted in an incident but did not, either by chance or timely intervention.
  • Incident: An unplanned event that does not result in injury or damage but has the potential to do so.
  • Near Miss Accident: An event that could have resulted in an accident but did not, either by chance or timely intervention.
  • Accident: An unplanned event that results in injury, illness, or damage to property.
  • Environmental Incident: An event that results in harm to the environment, such as a spill or release of pollutants.

Operational Phase

Preparatory
Operations
Processing
Reporting
Admin
Description of Operational Phases

If you are unsure about the operational phases:

  • Preparatory: Initial phase involving planning, resource allocation, and setup activities to ensure readiness for operations.
  • Operations: Active phase where the main tasks and activities are carried out according to the plan.
  • Processing: Phase involving the analysis, handling, and transformation of data or materials generated during operations.
  • Reporting: Phase where results, findings, and progress are documented and communicated to stakeholders.
  • Admin: Administrative phase involving support activities such as record-keeping, compliance checks, and other office-related tasks.

Department Concerned

Several departements can be selected

Production
Finance
Health
Security
Environment
Equipment
Corporate Image
Work Conditions
Admin

Description of the Event

Corrective action taken

Follow Up

The following Matrix describes the urgency of the actions. Select the importance and delay combination

Delay
Importance
Day
Week
Month
Semester
Year
Very High
High
Medium
Low

Proposition of correction to be taken

Verification