HSE Enhancement Form

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HSE Enhancement Form

"*" indicates required fields

Form Number: 2025/TS/QA/HS/069

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Employee ID*

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Employee Name*

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Position Description*

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Phone Number*

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Department*

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CEO Office Section*

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EM Section*

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Operations Section*

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HR , ADMIN & IT Section*

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HSE Section*

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Finance Section*

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TS Section*

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COD Section*

Exact Location*

Date*

MM slash DD slash YYYY

Time*

Hours

:

Minutes

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:*

Name

Designation/Department

Attachments if any

Drop files here or

Max. file size: 260 MB.

Concerned Facility Owner Dept. Approval & Action completion note:

HSE Enhancement Close out: (HSE Section)

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