HSE Enhancement Form "*" indicates required fields Form Number: 2025/TS/QA/HS/069 This field is hidden when viewing the formEmployee ID*This field is hidden when viewing the formEmployee Name*This field is hidden when viewing the formPosition Description*This field is hidden when viewing the formPhone Number*This field is hidden when viewing the formDepartment*This field is hidden when viewing the formCEO Office Section*This field is hidden when viewing the formEM Section*This field is hidden when viewing the formOperations Section*This field is hidden when viewing the formHR , ADMIN & IT Section*This field is hidden when viewing the formHSE Section*This field is hidden when viewing the formFinance Section*This field is hidden when viewing the formTS Section*This field is hidden when viewing the formCOD Section*Exact Location*Date* MM slash DD slash YYYY Time* Hours : Minutes AM PM AM/PM Please tick the appropriate box* Near miss Unsafe Act Unsafe Condition Safety Suggestion Process Hazard 1. Near miss: (Nature of hazard: ) Falling/ tripping/ slipping Unsafe Access / Obstruction Falling Objects Work platforms scaffolding/ ladder/ floor openings Others: Potential Outcome:*2. Unsafe Act: Tool and equipment PPE Work platforms- scaffolding Ladder In secured materials Others: Comment:*3. Unsafe Condition: Housekeeping Unrolled hoses Spills Tripping/ Slipping Obstruction to fire equipment Work platforms scaffolding/ ladder/ floor openings Others: Comment:*4. Safety Suggestion:*Related to Safety:* Yes No Estimated cost:5. Process Hazard Report: 1. Identify a hazardous condition. 2. Eliminate the hazard. 3. Complete this form and submit it. Process hazardous condition or Act: Fire & Explosion/ Material spill/ Chemical spill Others:*Action Taken:*NameDesignation/DepartmentAttachments if any Drop files here or Select files Max. file size: 260 MB. Concerned Facility Owner Dept. Approval & Action completion note:HSE Enhancement Close out: (HSE Section)
